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UNITED STATES BUREAU OF EDUCATION 

BULLETIN. 1913, NO. 48 WHOLE NUMBER 559 



SCHOOL HYGIENE 



A REPORT OF THE FOURTH INTERNATIONAL CONGRESS 

OF SCHOOL HYGIENE. HELD AT BUFFALO, N. Y.. 

AUGUST 25-30. 1913 



By W. CARSON RYAN. jR. 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1913 



Monograph 






BULLETIN OF THE BUREAU OF EDUCATION. 

[Note. — With the exceptions indicated, the documents named below will be sent free 
of charge upon application to the Commissioner of Education, Washington, D. C. Those 
marked with ^n asterisk (*) are no longer available for free distribution, but may be 
had of the Superintendent of Documents, Government Printing Office, Washington, D. C, 
upon payment of the price stated. Titles are abridged.] 

191S. 

*No. 1. Course of study for rural school teachers. Mutchler and Craig. 5 cts. 

No. 2. Mathematics at West Point and Annapolis. 

No. 3. Report of committee on uniform records and reports. 

No. 4. Mathematics in technical secondary schools. 
♦No. 5. A study of expenses of city school systems. H. Updegraff. 10 cts. 
*No. 6. Agricultural edncation in secondary schools. 10 cts. 

No. 7. Educational status of nursing. M. Adelaide Nutting. 
tNo. 8. Peace day. Fannie Fern Andrews, [Later pub., 1913, No. 12.] 

No. 9. Country schools for city boys. William Starr Myers. 
*No. 10. Bibliography of education in agriculture and home economics. 10 cts. 
tNo. 11. Current educational topics, No. I. 

*No. 12. Dutch schools of New Netherland. W. H. Kilpatrick. 20 cts. 
*No. 13. Influences tending to Improve work of teacher of mathematics. 5 cts. 
*No. 14. Eeport of American commissioners on teaching of mathematics. 10 cts. 
tNo. 15. Current educational topics, No. II. 

*No. 16. The reorganized school playground. Henry S. Curtis. 5 cts. 
*No. 17. The Montessori system of education. Anna Tolman Smith, 5 cts. 
*No. 18. Teaching language through agriculture, etc. M. A. Leiper. Sets. 
*No. 19. Professional distribution of college graduates. B. B. Burritt. 10 cts. 
*No, 20. Readjustment of a rural high school. H. A. Brown. 10 cts. 

No. 21. Urban and rural common-school statistics. Updegraff and Hood. 

No. 22. Public and private high schools. 

No. 23. Special collections in libraries. Johnston and Mudge. 

No. 24. Current educational topics, No. III. 

No. 25. List of publications of the United States Bureau of Education, 1912. 
*No. 26. Bibliography of child study for the year 1910-11. 10 cts. 

No. 27. History of public-school education in Arkansas. Stephen B. Weeks. 

No. 28. Cultivating school grounds In Wake County, N. C. Zebulon Judd. 

No. 29. Bibliography of the teaching of mathematics, 1900-1912. 

No. 30. Latin- American universities and special schools. E. E. Brandon. 

No. 31. Educational directory, 1912. 

No. 32. Bibliography of exceptional children. A. MacDonald. 
*No. 33. Statistics of State universities, etc., 1912. 5 cts. 

(Continued on p. 3 of cover.) 



UNITED STATES BUREAU OF EDUCATION 

BULLETIN. 1913. NO. 48 WHOLE NUMBER 559 



SCHOOL HYGIENE 




A REPORT OF THE FOURTH INTERNATIONAL CONGRESS 
OF SCHOOL HYGIENE, HELD AT BUFFALO. N. Y., 

AUGUST 25-30, 1913 



By W. CARSON RYAN, Jr. 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1913 







.>,v-^^v 



/ 



0. OF D. 

EC 10 vm 



^ 



\ CONTENTS. 



Page. 

Letter of tvaiismittal 5 

Part I. lutrodiictioii 7 

Part il. Abstracts of papers presented 14 

I. General discnssions 14 

A. School hygiene and child life. Sir James Grant 14 

B. The State's dnty in health supervision. Engene H. Porter, 

M. D 15 

0. Some health needs of school children. Joseph Lee 10 

D. Some inii)ortant factors preveriting nornnil growth and de- 

velopment in school life. D. P. Mac^NIillan IT 

E. Xotes on the health care of school children. S. Adolphns 

Knopf. M. D - 10 

IL Medical inspection 22 

A. A working plan of securing medical inspection. Alfred 

B. Morrill 22 

B. Medical inspection in Ilochester. George W. Goler 24 

C. Medical inspection in cities of 100,000 or less. Clinton 

P. McCord. M. D 2.-3 

D. Medical inspection in Massachusetts: Correlation of worK 

of school physicians and local and State health officers. 

W. C. LLmson. M. D 28 

III. Hygiene of the school building 28 

A. The hygienic construction of schoolhouses from an archi- 

tect's standpoint. ^V. H. Kilham 28 

B. Ventilation and recirculation. Luther H. Gulick 30 

C. Air washing as a means of obtaining clean air in buildings. 

George C. Whipple and Melville C. Whipple 31 

D. Tlie hygiene of the janitor. Homer H. Seerley 32 

E. The ideal school site. William H. Brainerd 33 

IV. Open-air schools 35 

A. Open-air school architecture. John H. Van Pelt 35 

B. Vitalizing school children, vraiter W. Roach. M. D 38 

C. Resolutions on open-air schools adopted by the Fourth Inter- 

national Congress on School Hygiene 39 

V, Oral hygiene 40 

A. Objects of the National Mouth Hygiene Association 40 

B. Methods of spreading the oral hygiene propaganda. George 

F. Burke 41 

C. Control of dental caries in school children. P. B. McCul- 

lough 42 

VI. Conservation of vision 44 

A. Sight saving and brain building. F. Park Lewis, M. D 44 

B. School lighting, James Kerr. M. D 45 

C. Defective vision from the economic standpoint. Lewis C. 

AVe>=;sels, M. D 4G 

VII. School feeding 47 

A. History and present status of the movement. Louise 

Stevens Bryant 47 

B. The nutrition of school children. Ira S. Wile, :M. D 48 

C. Teaching nutrition values through penny lunches. Mabel H. 

Kittredge 50 

VIII. Sex hygiene 51 

A. Public opinion and sex hygiene. Charles W. Eliot 51 

B. The social emergency. William T. Foster 57 

C. Education versus punishment as a remedv for social evils. 

Hugh Cabot, M. D 50 

D. Points of attack in sex education. Thomas vr. Balliet 01 

E. Character and the sex problem. Richard J. Tierney 62 

F. Some methods of teaching sex hygiene. Laura B. Garrett- 63 



4 COXTEXTS. 

Page. 

IX. Mental hygriene of the school child fU 

A. Child classificatioii and child hy;i:ieue. Arnold Gesell 04 

B. The distinctive contribution of the psychoedncatioual clinic 

to the school hygiene movement. J. E. W. Wallin G7 

C. Mental hygiene in the school. William H. Bnrnham 6S 

X. Athletics and health ^ 70 

A. Effects of athletics npon health. C. F. Srokes, M. D 70 

B. School athletics from a medical standpoint. J. W Kime, 

M. D 72 

C. Athletics for elementary schoolboys in Boston. Edgar L. 
Ranb 1 1 1 73 

XI. The reaching of hygiene 74 

A. Problems of the teaching of hygiene. Lillian jil. Towiie 74 

B. Protection of student healrh in the College of the City of 

New York. Thomas A. Storey, M. D !___ 75 

C. School health work in Mississippi. Susie V. Powell 77 

D. Museum cooperation in the teaching of hygiene and sani- 

tation. C. E. A. Winslow .—l 79 

E. An exi>erimeut in student control of school saniiation and 

hygiene. G. W. Hunter : 81 

F. ImproA-ing hygienic condirions among the native school chil- 

dren of Alaska. William Hamilton S4 

G. Hygiene in the Philippine schools. A. J. McLaughlin S6 

XII. Miscellaneous topics 87 

A. How women's clubs can aid the hygiene movement. Elsa 

Denison 87 

B. The school and vital statistics. Franklin C. Gram. M. D 89 

C. Accident prevention as relating to child welfare. Marcus 

A. Dow 90 

D. Intestinal parasites and the rural school. John A. Ferrell. 

M. D 91 

Part III. School hygiene exhibit 94 

Medical inspection 94 

The school nurse 09 

Oral hygiene 100 

Open-air schools 103 

School feeding 105 

Sex hygiene 107 

Exceptional children 108 

The school building and the janitor 111 

Athletics 111 

Child labor 113 

Hygienic dress for high-school girls 114 

Playgrounds 115 

IXBEX 117 



LETTER OF TRANSMITTAL 



Department of the Interior, 

Bureau of Education, 
Washington, October '/, 1913. 
Sir: The Fourth International Congress of School Hygiene, held 
at Buffalo, X. Y., August 25-30, was a notable event in the progress 
of health supervision as a part of public education. Because of its 
importance, a member of this bureau, W. Carson Ryan, was detailed 
to attend this conference and prepare a report of it. This report is 
contained in the accompanying manuscript, in three parts: 

I. An introduction giving a brief summary of the proceedings 
of the congress. 
II. A summary of some of the most important papers. 
III. Concrete data of the school hygiene movement as shown 
in the scientific exhibit made under the direction of the 
congress and in connection with it. 
I recommend that this manuscript be published as a bulletin of 
the Bureau of Education. 

Respectfullv submitted. 

P. P. Claxton. 

Conimisshner. 

To the Secretary of the Interior. 



SCHOOL HYGIENE. 



PART I. INTRODUCTION. 

Public opinion appears to have accepted health supervision as a 
part of the educational system, presumably on the sound basis of the 
social purpose of education. Health is, above all, socializing in its 
influences, since in respect to it the welfare of each individual is in a 
literal sense the welfare of all. Easy as this realization seems, in 
|oractice it has come very slowly, only under stress of public neces- 
sity, and even now the belief in school hygiene as a practical function 
of school work is by no means as well accepted in practice as in 
theory. 

So far as the United States is concerned, therefore, the most impor- 
tant fact in connection ,with the Fourth International Congress of 
School Hygiene recently held in Buffalo is that in some sections of the 
country at least the period of propaganda and experiment is yielding 
to that of actual result. There are now a number of communities in 
the United States that have had their school health work organized 
long enough to be able to give comprehensive reports of actual ac- 
complishment, and these reports were a most valuable feature of the 
scientific exhibit held in conjunction v>dtli the congress, as well as in 
the sessions of the congress itself. 

The two subjects that received most attention at the congress were 
open-air schools and sex hygiene. On the subject of open-air schools, 
sentiment was notably extreme. The delegates appeared to accept- 
unqualifiedly the idea that the benefits of fresh air should not be re- 
served for ailing children alone, but should be conferred upon normal 
children as well. Statements similar to that of Dr. Knopf, of New 
York, that " the open-air school must become the rule and the closed 
room the exception," were frequently made and as frequently ap- 
plauded. There were additional reports of the comparative physical 
and mental improvement of children in open-air classes, open-window 
rooms, and regular rooms; the part played by school feeding in the 
betterment observed in open-air school children was discussed on tiie 
basis of haemoglobin tests from a recent New York experiment; 
splendid pictures of open-air school work in mam^ cities were shown; 
the possibilities of open-air architecture were discussed by school 

7 



8 SCHOOL HYGIENE. 

architects; and the congress adopted a resolution calling on the 
American Government to follow the lead of Italy and place at the 
disposal of the various States abandoned battleships for use as float- 
ing hospital schools for tuberculous children/ 

The influence of the open-air propaganda was revealed in the reac- 
tion that appears to have set in against intricate and expensive sys- 
tems of ventilation. School architects seem to be less certain than 
formerly of the necessity of the elaborate ventilating systems that 
have been typical of modern city school buildings in this country. 

Sex hygiene was distinctly the problem that aroused greatest inter- 
est at the congress. Not only was the main evening meeting on the 
subject a large one, but an afternoon section meeting devoted to the 
question had to be held in the largest hall in-Buffalo. Over 2,000 
pei*sons listened intently to a discussion that was sensational, not 
only from the subject matter, but from the prominence of the 
speakers and the striking differences of oi^inion expressed. Senti- 
ment appeared hopelessly divided. There was general recognition of 
what President Foster had termed in his paper "the social emer- 
gency." It was felt that something ought to be done toward remedy- 
ing an intolerable condition; it was even admitted that the policy 
of silence had been a failure; but on the direct question of actually 
introducing instruction in sex hygiene into the public schools, there 
were two diametrically opposed points of view. 

On the one side were arrayed those who believe with Dr. Hugh 
Cabot that teaching control of the sex instinct is the function of the 
public school ; while on the other side are those who insist that, if the 
subject must be taught at all, it must be broached only in the home ; 
that knowledge of sex details imparted in a school course, or in any 
other way, is dangerous in that it is " apt to put forward by several 
years the time of temptation." 

It was clear from the discussion that medical men have gone much 
further on the subject than the public is willing to go vnth them; 
the most determined advocates of sex instruction were medical men 
of the very highest standing. Both sides admitted the urgent need 
for character training in connection with any instruction that might 
be given on sex, and several speakers declared that character building- 
must precede any attempt at sex education itself. Nearly all stressed 
the point that no matter how much knowledge might be needed, 
knowledge alone would not suffice. 

Many of the speakers were intolerant of the attitude of parents on 
the sex question. There was the usual doubt expressed as to whether 
children are really as ignorant of sex matters as many parents be- 
lieve them to be. Several speakers declared emphatically that par- 

1 For the full text of the resolution, see p. 39. 



INTRODUCTION. 9 

ents of the present generation are incapable of furnishing s-ex in- 
struction, particularly since they themselves have been wrongly 
taught. It was felt that before sex instruction can be imparted 
even in the home, a race of parents must be developed who have 
been educated in sex hj^giene as children in the public schools, and 
who will therefore be able to give sex knowledge to their children 
honestly and sympathetically. 

The Buffalo meeting may be said to have opened the sex question 
full and Tvide, if it was not so opened before. The next few years 
should see a rapid clearing of the situation through discussion and 
experiment. A beginning has already been made in Chicago and 
other cities toward instructing parents by means of lectures, though, 
as Mrs. Young pointed out, this is not strictly the duty of the public 
schools ; instruction has already been introduced more or less formally 
into the high schools in some localities through biology and hygiene 
courses; next will come the further extension of this high-school 
instruction, but there will be considerable lively debate before the 
step is taken. 

It should be said in passing that as a matter of fact many high- 
school teachers, by individual counsel and example, already give 
valuable aid in helping boys and girls over the dangerous age when 
they are least apt to be aided in the home; but this is entirely per- 
sonal and unofficial in character. It is when the proposal is made 
to put such guidance on a formal, official basis that it seems most 
questionable. It becomes at once' apparent that most teachers are 
even less qualified to give instruction in sex hygiene than most 
parents, and sex instruction in the hands of incompetents offers but 
little improvement over the present transmission of knowledge 
through vulgar channels. Sex hygiene in the hands of qualified 
physicians, however, assuming that such can be secured to do the 
work, is far more promising. 

It is in the general field of medical inspection 'that most has been 
accomplished in American cities in recent years, and of this develop- 
ment the Buffalo congress offered valuable evidence. Starting as a 
narrow preventive measure, to stop the spread of contagious disease 
by school children, the medical inspection movement has come to 
include a broad plan for the supervisional health care of all children, 
in and out of school. In many cities medical inspection is accepted 
as an integral part of the community's educational organization. 

An important problem in medical inspection is that of control. 
There has been little conflict of authority in American experience, 
and there should be none; but there can be a better balancing of the 
two agencies, health and school, than there has been and a stronger 
linking together of all the health-promoting forces. 



10 SCHOOL HYGIEXE. 

A more fundamental problem is the extension of health super- 
vision to country schools. Here again the rural school is much 
behind the city school. If medical supervision takes the course of 
other changes in education, it will proceed from the city to the State, 
and may eventual!}' reach all the rural districts if State supervision 
is made effective. Where there is a county organization the task 
of reaching the hygienic needs of the rural school is by no means 
impossible; but adequate State support and control are essential 
if this and other needed improvements are to be made in rural 
educational facilities. The beginnings of State medical inspection 
are visible in a few States. Colorado has a State plan that is 
reported to be working satisfactorily, Pennsylvania sends medical 
inspectors into remote country districts, and Kew York has a recent 
laAv providing for medical inspection in every school in the State, 
the results of which will be watched with interest. 

The growing realization of the importance of the school nurse 
in any system of medical inspection received added impetus at the 
Buffalo meeting. Philadelphia school and health authorities have 
recently made careful investigations to test the workings of medical 
inspection Avith and without the " follow-up " by school nurses. 
The results showed a real saving in school time and money through 
nurse service. Not only did the nurse service save the pupils time 
that would have been lost in returning to school, but in all instances 
the number of defects corrected increased with nurse service. This 
is the day of dollar efficiency, and the school system that can show, 
not" a mere temporarj^ saving, but permanent economy of operation 
in fulfilling community needs, educational or otherwise, is rewarded 
with public support. The advantages of school-nurse service are 
particularly susceptible to demonstration by the efficiency method. 
Furthermore, school-nurse service justifies itself on strictly peda- 
gogical grounds: The work of the school nurse is hygiene instruc- 
tion of the most direct and practical sort, and therefore belongs in 
the school's field, quite independently of other considerations. 

The development of dental inspection and dental clinics has fol- 
lowed quickly upon that of general medical inspection. In some 
cities, notably Philadephia, the dental clinics are now an integral 
part of the school health organization. Most often, however, the 
clinic is established by arrangement between the school board and 
some local organization of dentists interested in the care of chil- 
dren's teeth. This is but one manifestation of an oral hygiene prop- 
aganda that has been carried on vigorously both in this country and 
abroad. In this country the National Mouth Hygiene Association 
has aroused interest in the care of children's teeth by lectures, moving 
pictures, experimental clinics, and other means. Members of the 
dental profession are not exactly in accord, however, as to the course 



, IXTEODUCTION. 11 

to be followed in the future, some of them l^elieving- that more em- 
phasis should noAY be placed upon dental practice as represented by- 
proper nutrition and filling, and less npon propaganda. ; 

^Vnother item in the health care of children that received marked 
attention at Buffalo was that of vision. Care of the eyes is a task 
that is peculiarly the duty of the school, since school work is usually 
the chief factor in producing eye defects. The movement for con- 
servation of vision is in line with the modern tendency toward de- 
creased use of the printed page in early education. 

It is not quite clear how close the relation of dental clinics to the 
school health organization is to be. But here again the fact must 
not be lost sight of that one very definite aim of the dental clinic is 
instruction; it is to teach the child by the only successful method, 
that of practical example, the value of caring for the teeth, and 
inferentially for other parts of the human organism. The clinic is 
the present-day substitute for the physiolog}^ lectures and lessons that 
failed to teach the former generation of school children. 

The question of permanent connection with the school organiza- 
tion enters into another interesting hygienic movement, that of school 
feeding. Thci free breakfast and lunch, in the open-air schools, 
or the *' penny luncheon," elesewhere in the school system, is usually 
justified by its advocates on one or all of the following grounds: 
(1) Humanitarian — the children need it; one-tenth of the school 
children suffer from malnutrition; (2) public policy — the pupils do 
better work when better fed; (3) medical — diet is the first essential 
in treatment in the open-air schools; (4) economic — the children get 
more for their money in the school lunchroom tlian on the street; 
('5) educational — the children learn valuable lessons in nutritive 
values. :' 

The first reason, though humanitarian rather than pedagogical, 
may in some cases be imperative ; but the problem goes deeper than 
the school, and the school ought not to have to solve it. That all 
the pupils, anemic and well-fed alike, do better work when better 
fed is again a fact outside of the permanent business of education, 
though the school may be forced by circumstances to take cognizance 
of it and make temporary amends for societj'^'s neglect of its children. 
In the open-air schools, school feeding as a purely medical measure, 
applied without reference to the question of the school's special duty 
in the matter, should be safely beyond criticism. That the children 
get more for their money in the school lunch room than outside is 
a doubtful argument, unless the ''more" is clearly understood to 
mean more in nutrition values ; and even in that case it represents a 
combination of charity and business that is dangerous for argument. 
There is, however, very real validity to the claim made for school 
lunches as affording instruction in nutrition. Many school men and 



12 SCHOOL HYGIEXE. 

doctors believe that this one point, namely, the teacliing of proper 
diet through school lunches, is of sufficient importance to outweigh 
all objections that may be raised. 

Psychological clinics and the movement for mental classification 
which they represent formed an important topic at the Buifalo 
meeting. The progress already made in separating exceptional chil- 
dren in the public schools by means of formal tests and clinical 
observations is merely an indication of what may be expected when 
child classification becomes more generally adopted. In view of 
the fact that the psychological clinic is deliberately scientific in its 
aims and lacks largely the element of popular appeal inherent in 
school feeding and dental clinics, for example, the development of 
the idea has been remarkable. The possibilities of the psychological 
clinic appeal to the teacher who sees before her every day the problem 
of the child who is different; to the parent who genuinely desires his 
handicapped child to have a better chance; and also to the school- 
efficiency expert, who feels that the quality of tlie total product of 
education depends in large measure upon the scientific ascertaining 
of the individual needs of each child. 

As to formal instruction in hygiene, less was heard of it at Buffalo 
than at any meeting since health teaching became a recognized func- 
tion of the schools. The emphasis was on doing the thing rather 
than on any lesson about it. It was felt that children will learn the 
principles of good health far better by working under sanitary con- 
ditions in a sanitary schoolhouse than by reading about hygiene. 

Externally the Buffalo congress presented many interesting points. 
It was the first time the congress had met in the United States, and 
despite the holding of the fifteenth congress of hygiene and demog- 
raphy in this country less than a year before, the foreign attendance 
was all that could be desired. Prof. Leo Burgerstein, of Vienna, was 
among the distinguished European visitors. Several foreign nations 
were rej)resented in the scientific exhibit, notably Sweden with a 
most attractive and instructive booth, in which a bust of Per Ling, 
father of Swedish gymnastics, occupied the place of honor. Latin- 
America was particularly well represented at the congress. Two 
Cuban delegates presented an interesting piece of work in a " health 
primer" to be used as first reading in the elementary schools. Mexico 
had a highly creditable exhibit, showing especially the history and 
results of medical inspection in that country. Uruguay's splendid 
exhibit unfortunately arrived too late for installation, but her dele- 
gates took an active part in the deliberations of the congress. 
Largely in deference to the Latin- American representatives, Spanish 
was added to the list of official languages. 

The brief summaries of current contributions to the literature of 
school hygiene, prepared by Dr. Fletcher B. Dresslar and offered as 



INTRODUCTION. 13 

an exhibit of the Bureau of Education, formed a new feature that 
was deemed Avorthy of a permanent phice in subsequent congresses. 
"While they were by no means intended as a complete survey of the 
field, the thousand or more summaries prepared did cover a very 
wide range of school hygiene topics and were particularly valuable 
for the international view they afforded of the school hygiene move- 
ment. 

More than usual credit attaches to the citizens of Buffalo for the 
success of the congress. They not only financed the big meeting in 
the face of difficulties rarely encountered, but they manned the 
various congTess and exhibit committees with able men and women 
who served only for the honor of it. The city doubtless felt amply 
repaid not only by the cordial acx2eptance of its hospitality, but by a 
definite sense of the assistance rendered to school hygiene work in 
Buffalo. It is easy to overlook this one real benefit derived from 
educational meetings — the renewed strength and encouragement they 
give to the community which entertains them. This quickening of 
the civic pulse was distinctly noted in Bufl'alo as a result of the 
school hj^giene congress. 

Before adjournment the congress voted to convene again in Brus- 
sels, Belgium, in 1915. That the three-year interval hitherto pre- 
vailing is to be reduced to two years is in itself a tribute to the grow- 
ing importance of the school hygiene movement and the wider public 
appeal it is now making. Americans have a right to be proud of the 
work Dr. Thomas A. Storey and his associates have done at this im- 
portant epoch in the school hj^giene movement. 

In Part II, which follows, selected papers from the congress are 
presented in abridged form. In a majority of instances they are 
hardly more than abstracts; for the full text of all the pajDers the 
reader is referred to the Proceedings of the Congress. In Part II 
the purpose has been mainly to show the trend of current opinion by 
a few more or less representative articles. In Part III, on the other 
hand, concrete data and results shown in the scientific exhibit are 
given. The idea has been to select, here and there, for grouping 
under convenient topics what seemed to be the significant actual at- 
tainments in the progi-ess of school hygiene. 



PART IL— SELECTIONS FROM PAPERS PRESENTED. 



I. GENERAL DISCUSSIONS. 



A. SCHOOL HYGIENE AND CHILD LIFE. 

Sir James Geant, Canada. 

Few subjects are calling forth wider or^more diversified attention 
at present tiian hygiene, which aims to make growth more perfect, 
deca^^ less rapid, and death more remote. It treats of the laws of 
health in the widest acceptation of the term, and includes a knowl- 
edge of the causes of ill health and disease generalW, as yrell as pre- 
vention, together with the necessarj^ means of preserving health by 
strengthening and fortifying the whole system. 

Two exceedingly important problems are before us : The considera- 
tion of the child outside the school and the consideration of it in the 
process of education within the school. To accomplish a good and 
lasting work, care and inspection of a coming generation should 
include child life at home and in the school. The home stands first 
in importance, as the fundamental center of society. Two exceed- 
ingly interesting and attractive duties of parents originate and must 
be carried out in the home — first as to the child's food and second as 
to its education. The home, whether in country or city, is alike in 
these particulars.' All social movements relating to the welfare of our 
jDCople are rooted in the home, which absorbs all socializing agencies 
closely connected with the lives of our children. 

The food of the school child is second only in importance to that 
of the infant, and here rests greatlj^ the home responsibility of moth- 
ers as to the future of the child at school age. Modern school life is 
exciting, and food should be such as to quiet and soothe — plain, 
simple, and nutritious, easih^ digested and assimilated. Practical 
instruction to mothers on child diet would serve a good purpose and 
save many valuable lives. The necessity of a thorough knowledge of 
the diet of school children is gradually gaining ground, and school 
authorities are moving more actively in that direction. Tiny brains, 
phosphorescent and scintillating at every movement, can not be too 
carefully nourished in the formative process of mental development. 
Xervous troubles and imperfect digestive conditions are closely 
associated. 
14 



GENERAL DISCUSSIONS. 15 

Next in importance to pln^sical deA^lopment of the child in our 
schools is the iicquirements of knoAvledge. Mental hygiene and 
physical hygiene are inseparably associated in the essential balance 
of mind and body. The educational system of the present day is 
gradually becoming more cumbersome and complicated, and forms 
a serious test of strength to young brains in the plastic stage. The 
mental and physical well-being of youth should advance equally, 
and one of the most difficult and trjnng problems is how to build the 
best brains out of the material at our disposal. Educated evolution 
is closely associated with the development of mental power. Each 
brain, like each blade of grass, is single in character and power, and 
must be studied on its merits to fit it for the varied duties of life. 
The drawing-out process of education must be conducted with a 
thorough knowledge of the scientific principles involved to build 
the best brains of the material at our disposal. 

The pliant character of youthful brain tissue in the formative 
process of thought can not be too carefully guarded. An expert of 
the highest character, thoroughly informed in physiological and 
psychological principles, should be at the educational helm to guard 
life and intellectual endowment. How true is the sentiment of Hux- 
ley : '• Freshness and vigor of 3'outh must be maintained in mind 
as well as body." 

Careful school inspection is fortunately becoming generally 
adopted. Ten years ago there was only one medical inspector of a 
school board school in the whole of Scotland; at present there are 
not fewer than 105 such scientific experts, and in England and Wales 
fully 4:ZS inspectors. In Europe, Canada, and the United States 
this progTCssive idea is very generally adopted. In Edinburgh an 
impression is gaining ground that phj^sical culture comes before the 
humanities, and hygiene is reckoned of greater importance than 
higher mathematics. Simple and inexpensive school buildings are 
noAv advocated in i:)reference to palatial costly stone buildings. Well 
heated, well lighted, and perfectly ventilated, they will serve every 
purpose as satisfactorily as the more expensive structures, and they 
can be razed to the ground should necessity demand. 



B. THE STATE'S DUTY IN HEALTH SUPERVISION. 

EuGEXE H. Porter, M. D., 

Coniodssloner of Hcalih, Xeif York l<tatc. 

The State of Xew York, with nearly ten millions of people, spends 

mau}^ times more in looking after the health of its cattle than it does 

for the health of its citizens. In 1909 the health department had 

$14G,900, which was less than one-half of 1 per cent of the total 

13011"— 13 2 



16 SCHOOL HYGIENE. 

exi^ense of the State goA-ernment. At the same time the amount 
spent for the protection of game, fish, and forests was $568,595. 

We are all familiar with the waste of human life that goes on in 
our country day by day and year by year. Some of us know that 
much of this sickness and death is absolutely preventable. We are 
aware that just now we do not need to know more regarding the 
prevention of disease, but we do need to apply immediately and 
without further delay the knowledge that we noAv possess. 

Increasing knowledge has shown the futility of much of the mis- 
directed philanthropy of to-day. If a child is threatened with illit- 
eracy, millions of dollars are forthcoming for its education, but the 
child that is threatened with preventable disease is told : " Just now 
nothing can be done; wait until disease lias attacked you and you 
are helpless. Then there is a hospital provided for you and you 
will be taken there, and an attempt will be made to save your life.*' 
What we need to emphasize constantly is that it is not the curing 
of disease that is important, but the prevention of disease. Where 
one life may be saved by appropriate treatment a thousand lives may 
be saved by timely preventive measures. 

I believe thoroughly that it is the duty of health authorities to 
compel all citizens under their jurisdiction to cultivate habits of 
health, and to punish all who persistently refuse to acquire those 
habits, so far as the evils of neglect are in any sense a danger and a 
menace to the community. One of the unlimited educational possi- 
bilities of health boards consists in their privilege to point out 
repeatedly and cumulatively the industrial and community benefits 
which result from habits of health, and the industrial and com- 
munity losses which result from habits of unhealthy living. 



C. SOME HEALTH NEEDS OF SCHOOL CHILDREN. 

Joseph Lee, Boston. 

To the growing child, as to everybody else, a vigorous mental life 
is the greatest source of health. A good teacher is, accordinglj^, a 
first item in sound school hygiene. But in order that a good teacher 
may really reach the child, she must be given in sufficiently large 
doses; that is, not divided up among too many children. When we 
learn to care seriously about our children's health and education, we 
shall halve the size of classes in our elementary schools. To do so 
will increase the cost 80 per cent, but the children's lives and health 
are worth it. 

Further, to free the teacher's time, we must have special classes ; a 
special class not only for the blind, the deaf, the tubercular, but for 
all children requiring special treatment, including the specially bright 



GENERAL DISCUSSIONS. 17 

pupils to whom the regidar grades act as an intellectual hobble skirt, 
spoiling their natural gait perhaps for life. These special classes 
are good for the pupils requiring special treatment, but their greatest 
benefit is in releasing the teacher's time for the benefit of the normal 
pupils. 

We must have summer schools, because children grow in summer as 
well as in winter, and should have their mental diet supplied all the 
year round. The diet must of course be the right one and fitted to the 
season of the year. The three lower grades should have their after- 
noons outdoors, not in the schoolroom, partly that they may be free 
from the demoralizing influence of heavy pressure work, even more 
that the teacher may have time in the afternoons to take them, two 
or three at a time, and find out what they really need. 

We must look at the home, not as a boarding house, but chiefly for 
its spiritual contribution to health. W'hen by promiscuous school 
feeding we break down the responsibility of the home, we have in- 
jured the child even in his physical health more than ail we can do 
for him would ever atone. 

Finally, school hygiene is race hygiene. Childhood is the time for 
effective treatment of physical defects, and the school is the one place 
where everv individual can be reached. 



D. SOME IMPORTANT FACTORS PREVENTING NORMAL GROWTH AND 
DEVELOPMENT IN SCHOOL LIFE. 

D. P. MacMillan, 

Director of child, studt/ iti the public schools, Chicago, III. 

There are many children who are hygienically handicapped from 
the beginning of life. First, the chain of heritage is weakened in 
some links, and, of course, this goes back to unh3^gienic conditions 
and influences. Parents for many generations back have not known 
the first principles of right living, in which, though few have been 
willfully perverse, many were innocently ignorant. Children come 
into the world with incipient nervous disorders, which environmental 
factors early transform into overstimulated or understimulated nerv- 
ous systems. Again, diseases in early years are found to be associ- 
ated in the child's life with unhygienic states. Eight living, through 
proper surroundings and teachings, will ultimately make the so-called 
" inevitable children's diseases " a mere matter of curious history in 
child hygiene. Further, among these must be classed accidents to the 
child's health and person, although indeed, one advantage is often 
apparent in that very frequently these at once arrest the attention 
of parents and guardians to at least remediable and recoverable 
cases. Any discussion must take into account the desirability of 



18 SCHOOL HYGIENE. 

considering cleanliness of family life, adequate and appropriate 
clothing for all kinds of activities, as^vell as purity or impurity of 
the air breathed in cramped and darkened home quarters; but above 
all we must begin Avith diet, rest .periods, and educative muscular 
activity. 

Most potent, because it is the most vital, constant, and controllable 
factor during the periods of infancy and childhood, is the dietary of 
the child. The food provided may not be sufficient, and this reaches 
out to social economics ; it may not be properly balanced and adapted 
to growth needs in general or in particular to the needs of the indi- 
vidual child's system; it may be irregularly partaken, and this is 
dependent to a large degree upon the habits of the home; it may be 
poorly selected food, cheap, old, decayed, and is very frequently 
unhA^gienically cooked. Finally, as so often occurs, the children 
are not educated to eat properly. 

Xext to improper food in all its parts as a deterrent of normal 
growth must be recorded the factor of irregular, inadequate, or dis- 
turbed sleep. According to our experience, this does not apply to 
the poor and needy or the lower section, financially considered, of the 
fairly comfortable social strata of a metropolitan school population, 
as frequently as to the children of the comfortable and well to do. 
With the latter not infrequently late hours, social gatherings, and 
excessive indulgence through the day cause nervous exhaustions, the 
injurious effects of which continue to show themselves well along into 
the adolescent period, and are often wrongly blamed on the school 
regime. Ail this indicates the necessity for popular education to 
reach back into the early and later home life of children, not only 
indirectly, but directly in some positive ways. 

Further, the clean, well-clothed, and properly fed young genera- 
tion, provided with fresh air and adequate sleep, is still poorly fur- 
nished for a life of efficiency if the remaining vital factor affecting 
normal development is not assured — namely, educative muscular ac- 
tivity. Educators are just awakening to the vital significance of 
this for our present generation as a hygienic consideration of primal 
importance, and every physical and mental test and measurement 
bears out the suspicion of our first inspections and observations. Free 
and directed plays and games and ordered regular exercise in munici- 
pal playgrounds, social centers, and school yards, merely point the 
need and the way to begin early and adequately to round out the 
physical and mental h3^giene of the child in educative muscular 
activity. 

These factors, which operate as handicaps to normal development 
in infancy and earl}- childhood, continue their prejudicial influence 
with cumulative power in school life, and otu' attention is most often 
called to their after-effects, such as physical disorders, physical de- 



GENERAL DISCUSSIONS. lO** 

fects and their correlates, mental dullness, incorrigibility, and even 
juvenile crime. All departures from normal of this character are 
merely symptoms of these underlying" conditions of hA'gienic living 
which ai'e outraged, neglected, or inadequately provided for. 

Defective eyesight and hearing, difficulties in breathing, hyper- 
trophied tonsils and adenoid tissne, decayed and painful teeth, all 
noncommunicable defects and contagious diseases of every sort have 
come to be considered as preventives or deterrents to normal growth 
and development of school children. Defects of the senses of sight 
and hearing, to which appeal is largely made in schoolroom activi- 
ties, are considered by some to be the primary causes of delay or 
derangement of normal development, and it must be admitted that 
the}' delimit the number and quality of sense impressions as well as 
contribute to the formation of injurious habits in schoolroom arts, 
especially in younger children, but they are by no means such potent 
deterrents as the deeper lying derangements, which we may group 
somewhat roughl}^ as nervous exhaustions and constitutional disorders. 
In looking over the records of the first 7,200 cases of exceptional that 
readily came to hand in our files, it was found that only 8 per cent are 
schoolroom problems because of defective vision, and a little over 6 
per cent of the total number require either special care or training be- 
cause of defectiA^e hearing, whereas over 40 per cent of the total num- 
ber are nervously depleted, ill-nourished, weakened in power of 
resistance, uneducated in the fundamental bodily activities of their 
years, apathetic in voluntary initiative, and lacking in bodilj^ control. 

As education has begnn once more to come into her own by includ- 
ing boclilj^ features, and all that belong thereto, so hygiene, or the 
science of well-being, must always be thought of in terms of the mind 
as well as of the body. And as we ascend in the scale of human values 
and cultural sensitivity, hygienic education demands the exclusion of 
all morbidities, self-consciousness, false motives, fears, envies, angers, 
all emotional neuroses, all disordered attentional habits, all deranged 
associational processes, every clogged or explosive act of will and 
inconsistency in thinking, until the best functioning of mind as v\'ell 
as body is the common attainment of our children. 



E. NOTES ON THE HEALTH OF SCHOOL CHILDREN. 

S. Adolphus Knopf, M. D., 
New York Postgraduate Medical School and Hostiyltal. 

The site for a school building should be on elevated ground, and 
as far as possible removed from traffic, dust, and noise. The build- 
ing should be sanitary, well lighted, and attractive outside as well 
as inside. 



20 SCHOOL HYGIENE. 

The janitor of a public, parochial, or private school should be a 
practical sanitarian. Daily cleansing or disinfection, when neces- 
sary, of classrooms should be obligatory. 

The toilet and Avashing facilities for children should be sani- 
tarily perfect. 

The rural school should not be less sanitary, less well equipped, 
nor less well managed than the public schools of a city. 

The more open-air schools we can have, the more outdoor instruc- 
tion in kindergarten, public schools, and colleges, the greater will be 
the physical vigor and strength of the pupils. 

If we wish effectually to prevent and stamp out tuberculosis in 
children, the open-air school must become the rule, the indoor class- 
room the exception. -^ 

If there is not ample room for playgrounds and separate open- 
air classes, the schoolhouse should have a garden, playground, rec- 
reation room, and some open-air classes on the roof. 

Let us send the child to the open-air, or fresh-air, school before 
its tonsils or adenoids are enlarged as a result of overwork indoors 
and fighting off dust and infection. 

If the indoor classroom must be used, the temperature and mois- 
ture should be properly regulated with the aid of the thermometer 
and the hygrometer, and the air kept in motion with the aid of a 
fan. These three devices should be as essential to the equipment 
of an indoor classroom as is the blackboard. 

Practical breathing exercises, judiciously taught, should form a 
part of the daily curriculum. 

Outdoor singing, outdoor recitation, botanical and geological ex- 
cursions, practical lessons in horticulture or in farming, should be 
introduced as often as the curriculum will permit. 

Inculcate the love for open-air life into the child at school and 
it will become a fresh-air apostle at home. 

So long as we permit child labor in factory, workshop, cannery, 
field, mine, or home, so long shall we have physically, mentally, and 
morally defective citizens. 

The well-known methods of daily medical inspection of all school 
childi'en to exclude those afflicted with acute or chronic infectious, 
general or local diseases, should be supplemented by a thorough 
physical and mental examination of every pupil by the school ph}^- 
sician on admission, and annual or semiannual reexaminations for 
tuberculosis, heart disease, insidious nervous afflictions, etc. A care- 
ful record of the physical and mental condition of the child should 
be kept and the result of each physical and mental examination re- 
corded. Teachers and all school emplo^^ees who come in close contact 
with the children should likewise be examined on admission and 
submit to periodical reexaminations. 



GENERAL DISCUSSIOXS. 21 

The tuberculous or predisposed, the nientally defective, delinquent, 
or backward children should have separate schools, or at least be 
X)laced in separate classes. 

A goodly number of the seemingly delinquent, defective, and back- 
ward children are of s^^philitic origin, and before classing them per- 
manently with the defectives a Wassermann test should be applied, 
and if positive, antisyphililic treatment should be inaugurated. 

The hopelessly feeble-minded and defective child should be ren- 
dered sterile before puberty. 

Health lessons and simple instructions in the prevention of dis- 
ease, such as tuberculosis for example, can easily be imparted to 
even the 3'Oungest child. 

Lessens in mental alertness, in what to do in hours of danger, 
such as the event of fire in school or at home, or a panic from what- 
ever cause, and instruction in first aid to the injured, are to my 
mind as essential as any health lessons. 

In case of epidemics of diphtheria preventive injections of anti- 
toxin should be giA^en to all children exposed, ^^^len parents object 
to this procedure, their children should be excluded from school until 
the epidemic has ceased. 

In case of typhoid epidemics antityphoid vaccination should be 
used. 

Every large community should have a special outdoor or fresh-air 
classroom for children afflicted with whooping cough. 

While all hindrances to the proper physical and mental develop- 
ment of the pupil should be remedied, such as adenoids and enlarged 
tonsils, poh^pi, or a deviated 'septum, defective e^^esight, hearing, 
or defective ' teeth, orthodental treatment for the correction of 
irregular teeth should not be neglected. The same should hold good 
for the treatment of any remediable unesthetic appearance in the 
child. 

The school curriculum should be so arranged that the mental strain 
shall not react unfavorably on the physical and moral constitution 
of the child. 

Sanitary fountains furnishing good, cool water should form part 
of the equipment of every school, and the drinking of plenty of such 
water should be encouraged. 

Xo 2^nblic school should be considered well equipped without its 
swimming tank of running water; no curriculum complete without 
swimming lessons. 

Gymnastics, calisthenics, esthetic and graceful dances, and ra- 
tional athletics should be taught to the boys and girls at school. 
These exercises will benefit the child's physique and give it a healthy 
and happy frame of mind. 



22 SCHOOL HYGIENE. 

No lesbon in public school should be longer than three-quarters 
of an hour. 

The teacher should knoAv the value of mental hygiene and realize 
that there is as great danger in teaching too much as in teaching too 
little. 

The trained psychologist should be one of the most important 
additions to any modern school. His help will be of mestimable 
value to teachers, parents, and pupils. 

Lessons in embryology and biology, leading to the explanation of 
sex relation and eugenics, should be given according to the age and 
understanding of the pupils, and in the higher grades preferably by 
teachers of the same sex as the pupils. 



II. MEDICAL INSPECTION. 



A. A WORKING PLAN FOR SECURING MEDICAL INSPECTION. 

Alfred B. Morrill, Walliugforcl. Conn. 

The problem of securing adecjuate hygienic conditions in our schools 
is one of educating the public. This is particularly true of the 
iinancial asiDect of the problem. In all communities where money 
must be voted, a campaign of education, not only upon the social 
and moral aspects of the subject, but upon the financial side as well, 
must be inaugurated. It must be shown that physical ill health 
costs money that can be saved by adequate medical inspection. It 
must be shown b}' tables of promotion rates, such as Dr. Ayres has 
worked out. for example,^ that retarded children mean added expense 
to the school system ; that medical inspection, by lessening the number 
of preventable retarded cases and bettering the promotion rate, will 
produce an actual saving in terms of dollars, teachers, school plant, 
equipment, and children's time. 

^Medical inspection, therefore, becomes a business ]3roposition. In 
a typical community with 250 children, for instance, a saving in 
the promotion rate of 10 per cent, if the children complete the eight 
grades on time, will be 175 years of schooling, representing an an- 
nual saving of S5.250 at the rate of $30 per child per year. The 
school plant needed for the accommodation of the children would be 
decreased $17,500. 

Here are some facts as to the need of medical inspection and 
what has been accomplished when adequate medical inspection has 
been established: 

- Ayrcs, L. P. The money cost of rtpetition veisiis tht' money saving through accelera- 
Ticn. Am. Sch. Hd. Jour., Jan., 1912. Also: Tlio effect of p;-oraotion rates on school 
€flBci«.ney. Am. Sch. B<1. Jour., May, IJJlo. 



MEDICAL INSPECTION. 23 

1. In contagious dii^eases. It can be shown that in places Avhere 
a thorough s3-steni of medical inspection has been established, the 
number of cases of diphtheria has fallen off tAYO-thirds, and scarlet 
fever five-sixths. 

2. In noncontagious diseases. Medical inspection eliminates a 
large proportion of the physical defects that have been proved to 
retard advancement throug^h the grades. The fact to be made clear 
is that failures of promotion are a large and positive force in in- 
creasing the cost of our schools, and that medical inspection will 
reduce the number of these failures; in other words, medical inspec- 
tion has a direct bearing upon the reduction of school expense. The 
initial cost is more than saved from the lowest standpoint of dollars 
and cents. 

Too great emphasis can not be given to the value of a public pre- 
sentation of the needs and benefits of medical inspection, in written 
reports or otherwise, before asking money for adequately doing the 
Avork. A discussion of the financial aspect of the case appeals to 
the practical men usuall}^ composing the councils Avhich fix the 
budgets or the communities which decide upon items of expenditure. 
A plan should be presented, giving an estimate of cost. 

Those striving for the introduction of medical inspection should 
always present a well-thought-out plan. The folloAving is sug- 
gested: {a) A dnilj inspection for contagious diseases; (h) an 
annual physical examination of each child; (c) a system of follow- 
ing up the parents to see that the children liaA^e the proper treat- 
ment; (d) team.Avork in cooperation of teachers, janitors, principal, 
and superintendent, with the physical director, school nurse, and 
medical inspector in the various phases of school hygiene. 

This work should be done by: (1) The room teachers, Avho make 
the A'ision and hearing tests, and can be taught to select children to 
be referred to the inspector on his daily rounds. These include: 
Children suspected of illness; children returning after unexpected 
absence; and those returning after having been excluded. (2) Medi- 
cal inspectors acting under the general direction of the superin- 
tendent of schools or of the director of school hygiene, (a) calling at 
each school as near the opening of the morning session as possible 
for the purpose of examining cases referred to them by teachers; 
(h) once a j^ear examining each pupil and recording the facts on a 
card for future reference. This could be done at any time in the 
day. and would take 10 to 15 minutes for each pupil. 

Such an examination is fruitless without a system of records and 
the machinerA^ for following up the cases needing attention. The 
inspector should diagnose cases, not treat them. The parents must 



24 SCHOOL HYGIENE. 

provide the treatment. Experience has shown that some parents 
■v\ill heed printed notices, but that many require a personal explana- 
tion, and that some need to be shown how. 

This has led to the introduction of tiie most indispensable factor, 
namely, the school nurse. The doctor visits for a fevv^ minutes, 
whereas the nurse devotes her entire time to the work. She is the 
most important feature of the whole plan. Her duties are briefly 
these: To aid and advise the teacher in her work and to act in 
emergency cases until the doctor arrives; to follow up children ex- 
cluded on accoimt of minor contagious diseases, such as scabies, 
impetigo, pediculosis, and ring^'orm; to visit the home and confer 
with the parent, either showing her how to treat the case or influ- 
encing her to put the child under the care of a physician. 

The nurse is the most efficient link between the home and the 
school. Her work is immensely important in its direct results and 
very far-reaching in its indirect influences. 



B. MEDICAL INSPECTION IN ROCHESTER. 

George W. Goler, M. D., 
Health Officer, Rochester, N. Y. 

In Eochester we have 12 medical school inspectors, 11 men and 
1 woman, working under the direction of the Health Bureau, for the 
physical inspection of 19,381 school children in 36 public schools, an 
average of 1,015 pupils to each medical inspector. Each inspector 
is assigned to a district in which he not only has school inspection 
work, including the vaccination of all unvaccinated children, but 
also the care of the sick poor, and the insane examinations in his 
district. He is assigned to from 2 to 4 schools, according to the 
amomit of the additional work in the district, the size of the school, 
and the number of pupils. In 1912 the work of each medical in- 
spector averaged as follow^s: Vaccinations, 450; visits to sick poor, 
200 ; office calls to sick poor, 100 ; maternity cases, 2 ; insane examina- 
tions, 40. 

The medical inspector is also called upon to make a weekly sani- 
tary survey of the school, covering heat, lighting, ventilating, and 
cleanliness ; to make a physical inspection of each child during every 
school year, and to record his findings on a card, so arranged as to 
follow up the child from grade to gr^de, and to present a written 
statement on one card of the physical condition of the child during 
its entire school life. 



MEDICAL INSPECTION. 25 

C. MEDICAL INSPECTION IN CITIES OF 100,000 OR LESS. 

Clinton P. McCord, M. D., 
Chief Medical Inspector of Schools, Alhanu, N. Y. 

Medical inspection in onr pnblic schools is but the opening wedge 
for the broader idea of health direction. The term " health director " 
more accnratel}^ designates the functions of the officer who is to play 
a part, constantly increasing in importance, in our educational sys-. 
terns. 

Cities; of 100.000 population or less offer the fields where the work 
of health direction can be systematized in the most ideal fashion. 
These are the cities that in greatest numbers will introduce medical 
inspection in the next few years, and as the scope of the work broad- 
ens, the system may well be expanded toward the ideal plan of health 
direction, the beginnings of which we have in Albany. 

The health director should be a " full-time,'' specially trained 
physician, and should have under his direction a " full-time '' medical 
examiner to direct his energy toward the medical inspection phase of 
the system, and a corps of school nurses, > 

The system should be under the board of education, and sufficient 
apx^ropriation should be made to administer the work in a dignified 
and scientific manner. The privileges of the family physician must 
not be disturbed. Y^ith the awakening of the general practitioner 
to his responsibilities will come an increased cooperation with the 
health director, which is bound to advance the standard of health 
among children of school age and also may suggest methods of health 
supervision of children prior to the beginning of school life. 

There exist in the public schools five cliief highways to health: 
Medical inspection, school hygiene, personal hygiene, physical train- 
ing, welfare work. Health direction must take cognizance of them all. 

The health director should be the officer to keep the physical needs 
of the child before the public and the educational authorities. He 
should act as expert to the board of education on questions of school 
hygiene and to the superintendent of schools upon medico-pedagog- 
ical problems. He should pass upon the ph^^sical fitness of candidates 
for the teaching force and should act as consultant to the director 
of physical training, director of school lunches, and supervisor 
of special classes. His office should be made the clearing house 
for '' special case " children, where a properly equipped child-study 
laboratory and a person skilled in the use of psychological tests may 
aid in properly classifying these children, after which they may be 
assigned to the proper schools — open-air schools, open- window class- 
rooms, or schools for the mentally deficient. 



26 SCHOOL HYGIENE. 

D. MEDICAL INSPECTION IN MASSACHUSETTS— CORRELATION OF 
WORK OF SCHOOL PHYSICIANS AND LOCAL AND STATE HEALTH 
OFFICERS. 

W. C. Hanson, M. D., 

AssisUiiit Secretary^ Massachusetts State Board of IlcaUh. 

In a ]\IassacluiSGtts town with a population of about 10.000 inhabit- 
ants, inchiding a school population of about 2,000. two physicians are 
€niplo3'ed by the school committee as medical inspectors, at a salary 
of $150 per year. To supplement the work of the plwsicians a school 
nurse is employed at a salary of $800. Although physicians and 
nurse are alike responsible to the school committee, the}^ conduct their 
work in !-uch manner as they deem proper, without an}^ guidance or 
instructions from the committee. There is, tlien, no supervision of 
the work on the part of the school committee. Moreover, neither the 
physicians nor the nurses are familiar with the work of the local 
health officials. 

The school physician's business is to exclude from the school pupils 
found to be physically or mentally unfit for work, and those known 
to have any communicable disease; the local health official's business 
is to discover the source of infection of any and all cases of communi- 
cable disease in the community, within or without the school, and to 
do all within his power to prevent the spread of infection. 

The school physician, so far as he is influenced at all, follows the 
idea of the school superintendent of carrying out the original course 
of work that was planned at the beginning of the school year, and 
does everything that he can to prevent the school's being closed. The 
local health officer, on the other hand, when there is a case of scarlet 
fever or diphtheria, acting either with or without the advice of the 
scho-ol physician, closes the school through the power of the board of 
health to establish quarantine, and often unwisely and unnecessarily 
causes an interruption of the school curriculumx. 

Suppose, instead of the school physicians and nurses being in the 
employ of the school committees and having no official dealings with 
the board of health, the school and health inspection work is entirely 
in the hands of the local board of health, what then happens? 

In a Massachusetts city with a population of about 104,000, in- 
cluding a school population of about 18.000, there are six school phy- 
sicians in the employ of the board of health. Two nurses are also 
employed by the board to follow into the homes many of the children 
with defects or diseases discovered by the physicians. Each physi- 
cian and nurse does practically as he or she pleases, visits the school- 
houses and the homes of the pupils, and submits his or her report at 
iiTeffular intervals to the board of health. The board has issued no 
printed or written instructions. for the guidance of either physicians 
or nurses. One physician, for example, may and does take a great 



MEDICAL INSPECTIOX. 27 

deal of interest in his work, the interest carrying him along in it, 
even for the small salary of $200 per year, so that he does for the city 
far more than he is paid for doing; whereas another physician does 
his work in an irregular fashion, taking little interest in it, partly 
because of the small salar}^, and submitting his reports only when 
requested, if at all. 

But there is one saving thing about the work as conducted in this 
city — each school physician must report at once to the board of 
health every case of communicable disease in the school and in the 
community wherein the school is located, for he acts not only as 
school plwsician but as agent to the board of health. He has, how- 
ever, no idea of correlating the school and health work any more than 
has the board which employs him. 

From what has been said, therefore, it will be inferred that whether 
the school inspection work is conducted b}^ persons in the employ of 
the local school committee or the board of health it is not super- 
vised in the great majority of the cities and toAvns in the Common- 
wealth. This is a fact. 

^Vlv^t is the reason for this lack of definite supervision of the work 
of school physicians? The answer is, it would seem, the same as 
applies to all health work : Lack of sufficient interest and apprecia- 
tion on the part of the public as to the benefits that come from work 
of this sort if well done, and consequently lack of money to stand- 
ardize and put the work on a practical basis. 

Fundamentally it makes little difference whether school or health 
officials control the medical inspection of school children. The first 
essential is a thorough and well-super\dsed s^^stem of school health 
Tvork on the part of whichever board the local community in question 
sees fit to appoint. The second essential is a practical correlation of 
the school and community health work. ^AHiat is preeminently needed 
in Massachusetts to-day is the bringing together of the local commu- 
nities in such a way as to make it impossible for any single commiunity 
not to know what constitutes, in a place of its size and characteristics, 
the best practical sort of school-inspection work. 

]Massachusetts is particularly fortunate in having associated with 
the State board of health physicians whose cliief business it is to 
assist the local health authorities and to instruct and inform them, if 
necessary, on matters relating to the prevention of disease. They 
are, from the nature of their position, their training, and experience, 
competent to do just that sort of thing which results in bringing 
together the health authorities of neighboring communities. That 
was why the Commonwealth wanted their services. Having no 
autocratic powers over the local authorities, and standing as they do 
between the municipalities of Massachusettts and the health authori- 
ties at the statehouse, they accomplish to-da}^ much in the way of 



28 SCHOOL HYGIEiSrE. 

preventing disease that can not be definitely stated by the words of 
any written statute. 

Into the hands of these men, therefore, whose duties already take 
them to the cities and the towns, could be put the supervision of the 
medical school inspection of the State. Just as now they advise with 
the health officers and boards, investigate conditions and make recom- 
mendations, so they could advise with the school physicians, observe 
their methods and results, and by bringing to them definite expe- 
riences of similar communities with similar problems, incite that in- 
stinctive desire for high standards which comes so much more surely 
and vigorously by education than by legislation. 

State advisory supervision of school and community health work 
for the Commonwealth of Massachusetts is in the interest of economy, 
and is both logical and practical. It will insure local supervision of 
the medical inspection of schools, regardless of whether that work 
is controlled by the school committee or the board of health. It will 
gradually lead to a high and uniform standard of examination of 
the pupils throughout the Commonwealth ; it will preserve local inter- 
est and initiative in all health work; it will permit local officials of 
the school and health boards to have such infonnation in common 
as each needs, without duplication of work, and it will bring the 
State educational and health authorities together on a problem that 
demands combined action in the interest of the public welfare. 



III. HYGIENE OF THE SCHOOL BUILDING. 



A. THE HYGIENIC CONSTRUCTION OF SCHOOLHOUSES FROM AN 
ARCHITECT'S STANDPOINT. 

W. H. KiLHAM, Boston. 

So much advance has been made in the general matter of the 
hygienic construction of schoolhouses that it seems as if the last 
word must have been said as far as the architects are concerned. 
No longer is schoolroom air rebreathed by 50 pairs of lungs; the 
common drinking cup has been replaced by the bubbling stream; 
dust, once the bugbear of janitors, has fled before the combination of 
rounded corners and vacuum cleaner; the schoolroom is sunny, well 
lighted, warmed to a uniform temperature, and, in fact, almost 
sterilized by the various devices calculated to conserve the health of 
teachers and pupils. The city schoolhouse of to-day, compai-ecl with 
that of 30 years ago, seems to be almost a perfect structure. 

But there is another side. This germ proof, dustless building is 
also a very costly one. City after city passes large appropriations 
to provide the " most modern schoolhouse that can be built." With 



SCHOOL BUILDINGS. 29 

their complicated equipment, the construction of these buildings 
brings a formidable load on the helpless taxpa^^er. Ho^Y many of 
the requirements of these buildings are fads, and how many are in 
the class of things really worth while? 

About the most important single item of schoolhouse expense, both 
in construction and maintenance, is that of heating and ventilation. 
Tlie laws of Massachusetts and many other States provide that no 
new schoolhouse shall be occupied until after the installation of ap- 
paratus capable of delivering at least 30 cubic feet of warmed out- 
side air per minute to each occupant. In a large building this can 
only be satisfactorily accomplished by providing a ponderous ar- 
rangement of boilers, fans, ducts, and uptakes which suck into the 
building the vivifying air from out of doors, draw it through and 
over steam coils which rob it not only of every particle of moisture, 
but also of whatever freshness it ever possessed, then, sometimes 
after attempting to restore the moisture by a '* humidifier *' or " air 
washer." deliver it cooked, devitalized, and sterile to the children, 
who take it as a substitute for the winds of heaven. This sort of 
air is the present supply for not only schoolrooms and assembly 
halls, but even of gymnasiums. The successful working of a 
" plenum system '■ as above described depends absolutely on the out- 
side windows being kept closed, as otherwise the air would forsake 
its prescribed path in each room from the inlet register via 40 pairs 
of lungs to the outlet and immediately find an exit by the nearest 
opening. 

In my young da3^s I attended a public school which had been built 
in the year 1874 and was regarded as a model of all that a school- 
house ought to be, but the subject of ventilation had at that time not 
been seriously considered by architects. A hot-air register in the 
floor, with a wooden ventilating duct about a foot square, was then 
considered a very up-to-date arrangement. "\^Tien the air of the 
schoolroom in winter got to an impossible point, our progressive 
teacher would order a girl to the piano, open all the windows, and 
put us through a standing series of exercises done to lively music, 
until refreshed and invigorated we sat down for another go at the 
books. The pupils of this room had the cobwebs cleared out of their 
brains by drafts of real outside air, and there was no expense about 
if. To-day a 20-room school building of ordinary plan, costing, say, 
$110,000, has to cover 900 more square feet and contain perhaps 
40,000 more cubic feet, on account of space devoted to vertical lines 
of stacks. These stacks, built of brick or other fireproof materials, 
together with the horizontal ducts, cost perhaps $10,000. The cost 
of the plenum system over direct heating apparatus in such a build- 
ing would be about $5,000. The extra consumption of coal midit be 



30 SCHOOL HYGIENE. 

Viirioiisly estimated. \)iit probably aiiiounts to not less than 75 or 100 
tons per year. 

Experiments ^vith open-air classes have perhaps not yet demon- 
strated that perfection has been attained, but the testimony in general 
shcAvs that pupils in these rooms make a great advance both mentally 
and physically. It seems to me that much school work, especially of 
the kind done in '' study hours," couJd be profitably carried on in 
rooms built with Avindows only on one side so as to eliminate drafts, 
and made to open the entire size of the brick opening, and kept open, 
the extreme cold in Avinter possibh^ being tempered by direct steam 
coils. Eecitations and blackboard aa ork could be conducted in abso- 
lutely open rooms on the roof, made AA'ith glass sides to close AAdien 
the Avind is too strong. 

I am conscious that AAhat I haA'e said may seem AA^eak, reactionary, 
and absurd to those familiar AA'ith the problems of school operation. 
Under the preA^ailing laAYs indirect A'entilation to the extent of 30 
cubic feet per minute per person is obligator}^, and probably rightly 
so, for in AA'orking Avith open AvindoAA^s the personal element plaj^s 
perhaps too prominent a part and the difficulty of superA'ision be- 
comes too great. But if it is possible to giA^e the children invigorat- 
ing air and incidentally reduce the enormous cost of schoolhouse con- 
struction, I belieA'e the matter is AA^orthy of iuA^estigation, and the 
gratitude of parents and taxpayers A^^ill aAvait the successful 
inA'estigator. 



B. VENTILATION AND RECIRCULATION. 

Luther II. Gulick, Xe\y York, X. Y. 

We are uoaa^ able to account for the preA^alent acute dissatisfaction 
Avith A^entilation. For example, such ^nen as Dr. John AV. Brannan 
and Dr. W. Gilman Thompson are saying that the more perfect 
the SA'stem, the A\'orse the results in the great Xcav York hospitals 
under their charge. We uoay see that the trouble does not rest pri- 
marily either Avith the A'entilating apparatus nor Avith its operation. 
The trouble is that Ave hygienists have set up false standards. We 
have said: *' GiA^e each pupil 1,800 cubic feet of outdoor unbreathed 
air per hour.*' We noA\' knoAY that the important thing is neither the 
quantity nor the history of the air, but its condition. We haY^e 
striYen for absolute evenness of temperature, although Ave know well 
that variation in temperature is a necessary element in A^asometei' 
stimulation. We have been extreme in our endeavors to aA^oid air 
that has already been used. 

The great change in our standards is due to our discovery that the 
purpose of ventilation is not at all Avhat Ave had supposed. The air 



SCHOOL BUILDINGS. 31 

serves the body in two more or less overlapping groups of ways — one 
relates to the gaseous exchanges of the body, the other relates pri- 
ma rih^ to heat control. 

In order that the gas exchanges of the body should ])e perfectly 
performed, it is necessary that tlie air be pure, i. e., practically in 
those proportions usually found in nature. 

On tlie other hand, the heat control of the body is influenced by 
the condition of the atmosphere in which the body is immersed. 
This is exceedingly variable, and the problem of ventilation is to 
bring about the best conditions of air. In other words, ventilation 
seeks to control the conditions of the atmosphere in which the body is 
immersed, rather than to control its composition ; because its compo- 
sition is practically stable and needs no attention, while its condition 
is exceedingly changeable as well as important. 

The ideal ventilation for a school building consists in recirculating 
and properly conditioning its contained air. We have now arrived 
at such a knowledge of ventilation that it is possible to have indoors 
and practically all the time those conditions which are found out of 
doors only when nature is at her best. Man has at last accomplished 
with reference to the air he breathes and in which he is enveloped 
what he learned to do years ago with reference to the water he 
drinks — have it at its best all the time. 



C. AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS, 

George C. Whipple and Melville C. Whipple, Harvard Uiiiversiry. 

Clean air in motion and of proper temperature and humidity is 
necessary to indoor comfort. City air at the street level is dirt}^ At 
higher levels it is cleaner. Air at the fifty-seventh story of the AVool- 
Avorth Building in Xew York was found to contain 27,000 particles of 
dust per cubic foot as compared with nearly ten times as many at the 
street level. There was a similar decrease in the numbers of bacteria 
and molds. 

If dirty air is taken into a building through a badly located intake, 
it nullifies the effect of the ventilating sj^stem. Where it is impossi- 
ble to secure a supply of clean air, the purification of the air supply 
by washing is recommended. This process is like nature's process 
of atmospheric cleansing by rain. Tests of air washers used in Bos- 
ton showed them* to have an efficiency of about To per cent, but that 
higher efficiencies are possible. 

Experiments at the gymnasium of the Y. M. C. A. college in 
Springfield. Mass., showed the practicability of u.sing air over and 
OA^er, the air being washed and returned to the rooms. Such air was 
found to be l3etter than unwashed outside air, but not quite as good 

13011°— 13 3 



82 SCHOOL HYGIENE. 

as ouisicle air after washing. The advantage of recirculation lies 
in the saving of heat, which at Springfield was found to be npward 
of 40 per cent during winter weather. This lower cost of heating 
makes it possible to circulate larger volumes of air and increase 
indoor comfort. Air washing also removed bacteria, epithelial scales 
derived from the skin, and odors. 



D. THE HYGIENE OF THE JANITOR. 

Homer H. Seeeley, 
President Iowa St<>te Teachers' College, Cedar Falls, Iowa. 

The sanitation of the schoolhouse depends upon the school board, 
the teachers, and the janitor. The janitor is the servant of the pub- 
lic, and as such should be diligent in so conducting his part of the 
business as to conserve the welfare of the pupils. At the same time, 
the janitor is helpless in his endeavor unless he is granted the coop- 
eration and the sympath}^ of the school board and the teachers. Cer- 
tain preliminaries in construction, in environment, in appreciation 
of service, and in knowledge of the values of sanitation are essential 
to give the janitor a reasonable chance for success. "Without these 
necessary conditions the janitor can not maintain satisfactory stand- 
ards, and will gradually lose his disposition to seek improvement 
and develop excellence in all kinds of cleanliness. 

There must be a sanitary environment for every schoolhouse before 
there can be a permanence of sanitary conditions in the building 
itself. Many schoolhouses are so unfortunately located, the streets 
and the highways approacliing them are in such an unfavorable con- 
dition as to cleanliness, that it is impossible to pass over them and 
enter the schoolhouse without producing imhygienic conditions. To 
better these conditions is the task of the school board. 

The work of the janitor consists in keeping the building immacu- 
lately clean. This means that dust must be constantly removed from 
the walls, the floors, and the furniture of the building in its every 
})art. Prevention is alwaj'S easier than cleaning. Keeping the dirt 
out of the building is of more helpful importance than removing 
it after it is in. Janitor housekeeping includes the cleaning of 
blackboards, the cleaning of floors, and the removal of everything 
that should not exist under sanitar}' regulations. Sweeping with 
brooms is not to be commended as a complete process of securing 
hygienic conditions, since thereby dust is developed and scattered 
everywhere to the detriment of all concerned. Methods should be 
adopted that suppress the stirring of the dust that gets into a room 
and yet enable what is found there to be removed without undue 
complications and evils. Possibl}^ the vacuum systems of cleaning 



SCHOOL BUILDINGS. 33 

are great improvements on other methods in existence, but it is not 
likely that these systems can be universally adopted. Besides, the 
vacuum systems are unable to remove much dirt that adheres to the 
floor, walls, and furniture. Water remains the most valuable cleans- 
ing agency. Wiping floors, furniture, and even walls with clean 
w^ater and a woolen cloth for a mop gives the most permanent hy- 
gienic results. Clean water is better than soapy w^ater or any 
equivalent preparation, because it leaves no residue and gives a 
wholesome effect upon the atmosphere of the room. The only com- 
mendable use for a broom or a brush is as a preliminary agent, to 
take up the coarser particles which may have been dropped on the 
floor by the pupils; wiping with water is the final dependence in 
completing the work necessary to be done. 

It is well known that the educated and the trained representatives 
of the*people do not yet acknowledge and believe that the principles 
of school hygiene are worth while. Even the scholar is not neces- 
sarily a hygienist to any remarkable extent. Intelligence and clean- 
liness do not necessarily go together. Regard for knowledge and 
regard for health are not associated factors in civilization. Conse- 
quently churches, public buildings, private homes, hotels, and res- 
taurants are generally the most flagrant violators of the simplest laws 
of hygiene. It is therefore very difficult to get public attention to 
the necessities of school hygiene. The janitor does not receive the 
impression that a hygienic schoolhouse is required, and an indifferent 
public encourages him_ to be careless, indolent, and even unfavorable. 
It is possible that laws requiring suitable standards will be of some 
benefit ; it is possible that earnest and interested teachers can be of 
much influence ; but, after all, a higher degree of intelligence and of 
appreciation for scientific results must be brought to the conscious- 
ness of the masses of the people. To-day the States are sending out 
expert representatives to help the masses of the people to a better 
kind of agTiculture, to a better success in animal industrj^, to the 
making of more wealth and prosperity in business ; but when it comes 
to human health, human happiness physically, human progress in 
caring for human life, but few such experts are employed and but 
little instruction is given. 



E. THE IDEAL SCHOOL SITE. 

William H. Braineed, 

Architect, Boston, Mass. 

The essential sanitarj^ problems of a school are : To provide a place 
where instruction may be given with the minimum of fatigue and 
strain for pupils and teachers, and to provide hygienic conditions for 



34 SCHOOL HYGIEXE. 

the necessary accessories, such as corridors, toilets, playrooms and 
playgrounds. 

The question as to how these problems are affected by the site may 
be discussed under the following heads, arranged as nearly as pos- 
sible in the order of their importance: (1) Exposure to light; (2) 
surroundings; (3) space; (4) access; (5) proper conditions of soiL 
While the arrangement of heads is intended to be in the order of 
their importance, it may often happen that the advantages to be 
gained are so great under one of the less important heads, and the 
difference under the more important head so slight, that a considera- 
tion naturally of lesser importance may be the cause of the final 
selection of the site. 

1. Exposure to light. — The first purpose of the school is instruction. 
The first need of instruction rooms is light, for the use of the eyes 
and apparatus. Light must be in abundance and Y\'ithout glare. 
Sunlight should reach all instruction rooms, and others so far as 
possible. Long-continued, hot sunlight is not desirable in classrooms. 
The desirability of exposure for classrooms is in the following order : 
Easterl}^, southerly, westerly. For large buildings a site permitting 
of the major axis running northeast and southwest is most desirable. 
Classrooms should have the easterly and southerly exposure; assem- 
bly hall and accessories, westerly and northerly exposures. If the 
site provides sufficient exposure to light, the circulation of air will 
probabh/ be sufficient. 

2. Surrouiidhigs, — These should enhance, not detract. There should 
be nothing noisy or noisome. Light and quiet should not be im- 
paired. Beauty has positive hygienic value, by soothing and stimu- 
lating the mind. 

3. Space. — The space must be sufficient to allow of low buildings — 
generally two stories, and never more than three stories, except in 
crowded city districts. 

There should be open playground space amounting to from 30 to 
50 square feet per pupil. Other needs, such as school gardens, athletic 
fields, etc., should be considered. A southerly sloping hillside is many 
times desirable. Substitutes for accessory space may be found in 
adjacent municipal grounds or even in quiet side streets. 

4. Access. — The site should be central to the district served. This 
may be a question of transportation rather than geography. The 
site should not be exposed to the noise and danger of contiguous rail- 
road or street car lines, or main automobile thoroughfares. 

5. Conditions of soil. — Must provide for a dry building. This is 
generally more a matter of expense than of actual soil. A well- 
drained site with, if possible, a sand or gravel subsoil is desirable. 
In rural and toAvn schools the ranee of choice is generally sufficient 



OPEN-AIR SCHOOLS. 35 

to provide a suitable location. In older towns and in cities more 
important considerations may make wise the expenditure necessary 
to develop a poor site. 



IV. OPEN-AIR SCHOOLS. 



A. OPEN-AIR SCHOOL ARCHITECTURE. 

John H. Tan Pelt, 
Architect, Xctr YorJ:, X. Y. 

Unlike the architecture of the ordinary school, where experiment 
has prescribed the type, open-air schools have not yet been built and 
tried out. Ferryboats have been adapted to the purpose, open-air 
schoolrooms have been built or altered from old schoolrooms as 
minor parts of buildings, roofs covered and uncovered have been 
used, but the complete school, planned in all its details toward the one 
end, and of an advanced type, is yet to come. 

In describing the ideal conditions to wdiich I think such a school 
should conform, I have in mind a type slightly less radical than a 
school entirely out of doors wdth little more than a roof, but some- 
thing considerably more open than vrhat has been styled the low- 
temperature school. In other words, I propose a building so con- 
structed that the air in all parts of rooms w-here the children remain 
will be continual^ replaced by outdoor air that has only sojourned 
a few seconds within the limits of the building, yet not a building 
that is entirel}^ without heat. 

The ground for such a school should be sandy or gravelly without 
too much clay, so as to preclude a humid condition in the entering 
air. It should be protected from the w^ind by pine, spruce, or other 
trees suitable for screening; but these trees should not be too close to 
the building and should not cast a shade upon it. City schools should 
be so situated that sun wall not be cut off from them by adjacent skj- 
scrapers. This is also important, because the high buildings of our 
later construction cause concentrated air currents that Avould render 
work in an open-air school almost impracticable by blowdng papers 
and material about and forcing dust and dirt up and through the 
school. Exposed conditions, such as Riverside Drive in New York 
City, Avould be objectionable, rendering it difficult to protect the 
schoolrooms from violent storms. 

The orientation of the school should be such that sun will enter 
all classrooms during a part of any day in the year. This is espe- 
cialh^ important in such rooms as study rooms, where the children 
sojourn for a i^rotr acted period. 



36 SCHOOL HYGIEXE. 

Toilets a.re to be placed so that odors can not reach the open class- 
rooms. An insanitary condition of this kind will become particularly 
objectionable in AYarni weather. 

It is essential that the plan be so arranged that all classrooms, 
stud}^ rooms, the auditorium, and wherever the children sojourn, 
shall have ventilation on two or more sides; to fulfill conditions 
properly, the room should be open on at least two sides that are 
opposite to each other. An open gallery is advantageous. 

General plans may be divided into three classes — the U or H plan, 
where the wings are about open courts; the T or star plan, where the 
wings radiate from a center; and the inclosed court plan. The last 
named is not so good, and all plans should so inclose the courts that 
the latter are open on at least one side, which is not the north. This 
is to insure the entrance of the sun into all parts of the court during 
some part of the day. 

I see no objection to a building three stories high above basement, 
or even higher, if means of ascent can be provided. Open galleries 
and open staircases are good, pro^-ided they are protected from snow 
and sleet. A great advantage is that children passing between the 
cold rooms do not undergo a sudden change of temperature. Snow 
and ice are particularly dangerous in the staircases. 

Placing classrooms on the ground floor is objectionable because of 
the dust and odors from the street and the general impurity of the 
air. 

Overhanging cornices are good, because they afford protection 
from rain for the open windows, but on the top floor they cast a 
shadow. A sflass cornice, like a marquise, mi^ht be extended at the 
top of the building, or such protection might be constructed over each 
of the large windows. 

The auditorium should be so situated that it can be thrown entirely 
open. It may be convenient to have it arranged so that it can be 
closed for special exercises when visitors are present. 

Classroom windows must be so arranged that any side from which 
comes a heavy driving storm or a drifting mist can be closed. In 
such schools as the Providence school, one of the first open-air schools 
of the countiy, hinged windows were tried. They have not been 
found as advantageous as pivoted sash dividing the window into three 
parts, the upper half of the lower sash opening in, so that it projects 
above the head of a full-grown person. Such sash, somewhat in- 
clined to the outside, form a protection from slanting rain, throw^ing 
the water out of the building. Double-hung windows are possible, 
running up into pockets in the head of the window and Mow the 
sill of the window above, so as to leave the entire opening free. 



OPEN-AIR SCHOOLS. 37 

They are somewhat difficult to operate and do not afford any 
protection. 

Classrooms may have the floor warmed. This would slightly tem- 
per the air and keep the children's feet from becoming cold, tending 
to dry them if they had not come to school with rubbers. Wood 
floors are good to walk on, as they are not too hard, and very durable; 
but rain, snow, and dampness soak into them and are objectionable. 
Linoleum is good, especiall}^ if it can be cemented down. It wears 
out rather easily and is therefore expensive. Composition floors are 
somewhat expensive, but come within a possible range of prices. 

Coat rooms should be well ventilated, but kept reasonably warmed — 
about 65° Fahrenheit. This will appear quite warm to the pupils 
coming from the classrooms and halls, and a higher temperature 
would be uncomfortable before the smaller children could succeed in 
adjusting their clothes. It may be suggested that coat rooms could 
be omitted, in that the children wear about the same clothing in the 
classroom that they do out of doors. If they haA^e to come to school 
through snow and storm, their outer wraps should be taken off and 
dry wraps put on, and I believe it would be better to provide a proper 
place to keep such wraps, allowing the damp ones to dry. 

Furthermore, exceptional cases occur where fragile or anemic 
children suffer from time to time from the cold; the warmed cloak- 
room offers an excellent place where their vitality may catch up. 
Limited space may force wardrobes in the classroom, in which case a 
warmed room for recuperation should be provided on each floor. 

Toilets must necessarily be warmed, as the children have to remove 
some of their clothes, and in very cold weather plumbing j)ipes 
would freeze. A temperature of 60° to 65° is ample. Anything 
higher than this would be bad. Toilet rooms should be screened to 
l^revent insects from entering through the open windows. 

In spite of the fact that such a school is open and a considerable 
amount of heat lost, the fact that the average temperature of the 
building is kept so m_uch lower than is ordinarily the case will prob- 
ably cause a slight saving in coal over the usual type of schoolhouse. 
Hot-water systems can not be used, owing to the danger that pipes 
and radiators may freeze. Hot air is useless, as it can not be con- 
trolled in such a building. Steam and water vapor are therefore the 
onl}^ possible means of heating, and w^ater vapor is hardly effective 
enough under the conditions that usually obtain. 

The acoustics in such a building play an exceedingly important 
role. In an auditorium, they must receive special study, as the open 
windows supply the equivalent of total absorption, and, furthermore, 
allow exterior sounds to penetrate. This would make speaking in 
the room more dead, and in the noisy quarters of a city, exterior 



38 SCHOOL HYGIEXE. 

sounds would become predominant. In the classroom, the question 
becomes quite important. Where chissrooms are opposite each other, 
across a somewhat narrow court, the sound might be thrown from a 
wall opposite the windows over to the opposite room. In certain 
cases, a glass screen could be built in front of the windows, deflecting 
the travel of the sound to some extent, without permitting light to 
penetrate the room. 

In the matter of light, the general color of the classrooms should 
be that of the ordinary room, except that it must be kept in mind 
that too light a wall reflecting a glare from the snow on a winter's 
da}' would be tr3dng. As a much larger quantity of light will prob- 
ably penetrate the rooms than ordinarily enters a classroom having 
glass areas of only 20 to 25 per cent of the flot)r area, the walls of 
the room might advantageously be somewhat darker. 



B. VITALIZING SCHOOL CHILDREN. 

Walter W. Eoaci-i, :\I. D.. Pbiladeliaiia. Pa. 

At the Alexander Dallas Bache School, in September, 1912, we de- 
cided to study the effect of low-temperature classroom work on the 
educational processes of the children. Two groups of normal third- 
grade pupils were available for the test ; one group occupying a room 
heated and ventilated in the usual manner, and the others, with the 
consent of their parents, all through the winter in a classroom with 
the windows wide open. Both groups of children followed the regTi- 
lar school program, and we observed their work carefulh^ 

The windows of the one room were kept constantly down from the 
top and up from the bottom, and the room was cut off from the regu- 
lar heating plant of the building. The ordinar}^ desks were removed, 
and rei:)laced with chair desks which could easily be moved by the 
pupils themselves to clear the floor space for frequent physical exer- 
cises. As cold weather approached the children were provided 
Avith woolen sweaters, worsted caps, soft woolen blankets, and knitted 
woolen gloves. Thus their lower extremities were protected from the 
cold floor with no disturbance of the circulation. 

AVeek by week during the fall and winter and spring we weighed 
and examined these pupils, Avatched their^study and their play, and 
compared their scholarship with that of the children in the warm-air 
room. The children from both rooms came from the same kinet of 
homes, so that the test was as fair and as accurate and searching as 
possible. As might have been expected, we found at the end that the 
pupils in the open-Avindow room had gained on an average more than 
twice as much in weight as those in the warm-air room. They kept 



OPEN-AIR SCHOOLS. 39 

wliolly free from colds, and were much more I'egular in attendance 
than the others. 

Tlie experiment Avas not made primarily to prove that fresh air is 
good for healthy normal children in school. In these days the gospel 
of sunshine and pure air is accepted and ought to need little preach- 
ing, ^lany school boards do not, however, practice the doctrine that 
their members believe in and preach. Tlie average schoolroom is 
maintained at too high a temperatuie, and ventilation as a rule is 
poor. 

To conclude: The beneficial effect of open windows on the health 
and scholastic progress of pupils can be attributed to the following: 

Volumes of pure, fresh, cool air roll into the room with none of 
the vital cpialities impaired by artificial handling. 

Nature's proper proportion of moisture is mixed with this atmos- 
pliere and nature's variation is a beneficial change. Ventilating en- 
gineers have made the mistake of trying to establish a norm and stick- 
ing to it. 



C. RESOLUTIONS ON OPEN-AIR SCHOOLS. 

(Adopted by tlie Foinlli Iiiteniatioiial Congress on Scliool Hygiene, Aug. 29, 

1913.) 

IVhereas, Nearly a million tuberculous children or children 
strongly disposed to tuberculosis are attending our public schools 
and there is hardly accommodation for 1,500 to receive instruction 
in the open air. and— 

Whereas, The congress is conA'inced that the open-air school is one 
of the most powerful agents in the prevention and cure of tubercu- 
losis, and it has been ftirther demonstrated that nearly all climatic 
condition^, providing the air is dust free, lend themselves to the 
prevention of tuberculosis in the predisposed and the care of the 
afflicted, and — 

IVherecfs, Statistics show that there are not nearly enough hospital 
and sanatorium accommodations for adults and children afflicted 
with pulmonary tuberculosis or children suffering with tubercidous 
joint or bone disease, and — 

Whereas. It has been demonstrated in New York and other cities 
that discarded vessels lend themselves admirably to transformation 
into all-year-round hospitals and sanatoria for consumptive adidts. 
sanatoria for children afflicted with joint and other types of tuber- 
culosis, and into open-air schools for tuberculous, anemic, and nervous 
children: be it — 

Resolved , That the Fourth International Congress on School Hy- 
giene petitions the United States Government to place at the disposal 
of the various States of the Union as many of the discarded battle- 



40 SCHOOL HYGIENE. 

ships and cruisers as possible, to be anchored according to their size 
in rivers or at the seashore, and to be utilized by the respective com- 
munities for open-air schools, sanatorium schools, sanatorium schools 
for children, or hospital-sanatoria for adults; be it further — 

Resolved^ That the congress expresses its appreciation to the 
Italian Govei'nment of the example it has given by consecrating three 
of its n)en-of-war to the combat of tuberculosis: be it further — 

Resolved^ That this congress expresses the sincere wish that other 
Governments may follow the example of Ital}^ ; and be it finally — 

Resolned^ That copies of these resolutions be presented to the 
American and other Governments represented at this congress. 



V. ORAL HYGIENE. 



A. OBJECTS OF THE NATIONAL MOUTH HYGIENE ASSOCIATION. 

W. G. Ebersole, 
Secretary-Treasurer , Cleveland, Ohio, 

'' First. To teach the importance of healthy mouths to the health, 
strength, and beauty of the individual. 

Second. To teach methods which will change the conditions in the. 
public schools so that danger to both teachers and pupils from dis- 
ease will be no greater than that outside the schoolroom. To en- 
deavor to have the public thoroughly appreciate the value of the 
service rendered by the public-school teachers of the land, to create 
a sentiment for the paying of salaries commensurate with the service 
rendered and the risks assumed by them. 

Third. To teach how to properh^ care for the mouthy including 
advice as to the use of tooth pastes, powders, and brushes. 

Fourth. To teach the people the proper kind of food to use and the 
manner of masticating, so that the teeth may become strong and the 
mouth healthy. 

Fifth. To teach the people to know and understand the value of 
good dental service and to instruct them how to command it. 

Sixth. To teach the public to shun people with diseased or dirty 
mouths. (One dirty or diseased mouth in a room where all other 
mouths are clean will fill the air in a few minutes with disease germs 
that will produce the disease in the others. As proof of this, consider 
how quickly colds, diphtheria, scarlet fever, measles, and many other 
diseases are communicated from one person to another.) 

Seventh. To encourage the establishment and maintenance of medi- 
cal and dental clinics to care for worthy, but unfortunate, people. 



OEAL HYGIENE. 41 

Eighth. To do these thmgs by an endless-chain system of securing 
memlDers and coworkers for the National Mouth Hygiene Associa- 
tion, who will not only pledge themselves to employ mouth-hygiene 
methods personally, but will also pledge themselves to make a faithful 
effort to secure five others who will become members of the associa- 
tion, making like pledges to follow mouth-hygiene methods and 
secure other members. 

Ninth. To establish junior auxiliaries to the National Mouth 
Hygiene Association among the school children of the country, for 
the purpose of arousing their interest in our campaign. 



B. METHODS OF SPREADING THE ORAL HYGIENE PROPAGANDA. 

Geobge F. Burke, Detroit, Mich. 

Those who plead for universal oral hj"'giene are practically preach- 
ing a new doctrine. The great mass of human beings, those Avhom 
it is most necessary to reach, have never heard of it. Nor are they 
keen for the news. They are already bored to death with all the 
new preachments that have been thrust upon them during the past 
few years. The great humanitarian wave that has been rolling larger 
and larger has touched them again and again, not onh^ to bring 
them relief, but to urge new efforts and impose new obligations upon 
them. 

It is a matter of education among the high and the low, the wise 
and the foolish. But education, even of the most superficial kind, 
is a slow process. How shall we send out the news into the high- 
ways and byw-ays? How let the fathers and mothers know that 
often their children are frail and sickly, because they are ill-nourished, 
in spite of plenty of food? How show them that malnutrition is 
directly due to the wrecked teeth, the black ugly stumps, foul -and 
diseased, that might have been white and sound, supplying the 
means that nature provided for the proper mastication of food and 
the resultant well-nourished bod}^? 

There is much criticism in our day of the press. How much or 
how little of it is deserved I do not know, but I do know that there 
is no power so overwhelming, so far-reaching, so swift and i^enetrat- 
ing as this power of the press. The papers reach all the people all 
the tim^e. 

Tq, the newspapers I can not give too large a share of the credit 
for the success of our movement in Detroit and Michigan. Intelli- 
gent and sympathetic reports of the efforts being made by some of 
the dentists to save the children in this regard were given in the 
news columns; interviews on the need and the best methods of meet- 



42 SCHOOL HYGIENE. 

ing it Avere used ; editorials setting forth the meaning of this special 
jDhase of the big humanitarian impulse ATere printed in all the papers. 
Moreover, there were the Sunday feature stories, Avith their strik- 
ing headlines across the entire page, and illustrated to show graph- 
ically hoAv terrible a thing the rieglected mouth may become. 

I should say that no scheme for spreading the doctrine and ex- 
tending the practice of oral hygiene was ideal without lectures. 
Well-deliA'ered. popularly treated, illustrated lectures vrill carry the 
message to hundreds ayIio otherAvise would be unreached. In Detroit 
the Federation of Women's Clubs has for years maintained a series 
of Avinter lectures giA^en eA'enings in the schoolhouses, in the social 
centers and settlements, and in the A'arious clubs organized among 
the men and women of the Avorking classes. There is such a strong 
penchant for organization of eA-ery sort and kind in our day that 
it is an easy matter to find groups of people gathered for an eA'ening's 
diA'ersion. If you can teach them a new lesson pleasurably they will 
listen. The story of AAdiat ruin a neglected mouth may work is not 
without its dramatic jDOssibilities. 

Lectures, inspection of the teeth of school children by dentists, 
clinics, as man}^ and as Avell adA^ertisecl as possible, ahyays with the 
backing of the press and their cooperation in printing stories — these 
are the media through Ayhich the child may be helped and saA^ed from 
the tragedy of a AA'recked, diseased, and disease-producing mouth. 



C. CONTROL OF DENTAL CARIES IN SCHOOL CHILDREN. 

P. B. McCrLLOUGH. 
Chief of the Dental Division, Bureau of Health, PhiJadeJphia, Pa. 

The undefined though expressed policy of the oral hygiene propa- 
ganda has been to instill into the popular mind the belief that the 
care of the teeth, such as may be practiced at home, will preA'ent 
dental caries. 

The futility of this teaching becomes apparent after consideration 
of the forces instrumental in producing decay. Like other organs, 
the teeth are a product of the nutritional supply. When this is in- 
adequate the teeth sIioaa^ the effect, and their resultant incomplete 
deA-elopment is not remedied by the toothbrush. 

Miller proA'ed that the actiAe cause of caries is the acid secretion 
of microorganisms in the main lactic acid fermentation. More recent 
inA'estigations tend to shoAA^ that caries is preA'alent AAdien the char- 
acter of the saliAary secretion is faA'orable for the groATth of the 
acid producing bacteria. 

It folloAA's by deduction that the theory of a perfect nutritional 
balance is fundamentally the secret of prevention of caries. In- 



OEAL HYGIENE, 4'3 

adequate iiutriment during the developmental period results in in- 
complete enamel formation, and after eruj^tion of the teeth the 
saliva, influenced by the character of the diet, hastens decalcification. 
The school dental clinic is offered as a definite measure for control 
midway between adequate nutrition as a municipal problem and 
oral hygiene as the latter is now preached. 

Clinical evidence shows that certain permanent teeth are decayed 
at 1, 2, and 3 years after eruption, or at T, 8, and 9 years of age, 
because these particular teeth are incompletely developed at the 
time of eruption. In them are minute crevices providing lodg- 
ment for the acid-producing bacteria. The first requisite, therefore, 
is that these natural imperfections shall be artificially repaired, and 
for this condition the only known remed}^ is filling. 

The first permanent molars are four — two lower and two upper — 
erupting back of the last temporary molar, which is the fifth tooth 
from the median line on each side of each jaw\ The development of 
these •' sixth year *' molars begins at the eighth month of prenatal 
life: calcification of the enamel is complete at about the fifth year; 
they erupt, as stated, at 6 years: while the roots attain their full 
growth in the tenth year. Not only is the development of these 
teeth influenced by maternal environment before birth, but their 
subsequent development occurs during that period of infancy and 
earh^ childhood when mortality is greatest. Since inferior food is 
supplied to both infants and children in city districts, development 
is bound to be extremely poor. It is not surprising, therefore, that 
after tabulating examinations which we have made of 9,953 children 
of elementary school age, we find 23,325 first permanent molars lost 
or decayed, or that of these four teeth nearly three to a child are 
decayed. 

Man is most susceptible to dental caries during- that period of life 
compassed by the elementar}^ school age. It is therefore during this 
time that dental service is of greatest value. The first permanent 
molars require this service two to one of all the other permanent 
teeth combined. Simple' cavities in these teeth can be filled in from 
15 minutes to 1 hour ; cavities involving the pulp in these teeth require 
about 5 hours to a tooth with visits covering several days. 

We assume at the outset to be responsible for the control of dental 
caries in every child examined, with the single proviso that the 
patient make the number of visits required, in order that a discharge 
liiay signify that all the work indicated by the first examination has 
been completed. Patients are discharged for from six months to one 
year„ 

The task of obtaining control of caries is not nearly so formidable 
as it may seem. Twenty dentists can obtain control of dental caries 
in 100.000 school children in five years. This statement is based uDon 



44 SCHOOL HYGIENE. 

the number of patients treated and the number of operations actually 
performed in one 3^ear in our dispensaries. It is is misleading in this 
respect, namely, that the number of discharges does not equal the 
number of new patients recorded. It does, however, indicate what 
can be done. It also makes patent this fact, that to claim control 
that can be attested means that in each year the discharges must 
approximately equal the number of examinations made, and that the 
policy must provide for the enforced attendance of the child until 
discharged. 

As for brushing the teeth, we insist upon it as a sanitary measure, 
as we would the bath,, but we do not share the general belief that the 
toothbrush will prevent dental caries. 

Next to adequate nutrition, mastication is- the greatest develop- 
mental agent. Mastication is also the greatest cleansing agent and 
only sound teeth will be used. Children's teeth need only to be 
properl}^ filled and made regular, and even green stain will disappear 
with this treatment and proper diet. 



VI. CONSERVATION OF VISION. 



A. SIGHT SAVING AND BRAIN BUILDING. 

F. Pakk Lewis, M. D., Buffalo, N. Y. 

It is an accepted fact, recognized by ophthalmologists everywhere, 
that changes occur in the eyes of children during the period of their 
school life, of which the most prominent symptom is a steadil^^ pro- 
gressive developme2it of nearsightedness. As definitely formulated by 
the late Prof. Dufour: (1) In all schools the number of shortsighted 
pupils increases from class to class. (2) The average degree of short- 
sightedness increases from class to class. (3) The number of short- 
sighted pupils increases with the increase in school demands. 

This form of myopia is dependent upon a relaxation of the tissues 
which give form to the eyeball, resulting in a gradual stretching of 
the globe itself. It is not dependent upon constitutional weakness; 
neither is it due to bad sanitary environment. It is not merelj'' an 
abnormal phase of development which is fortuitous in its manifesta- 
tion. It is a logical sequence of conditions which may be recognized 
and controlled. Its beginnings are, primarily at least, due to con- 
genital astigmatism and the consequent strain upon the accommoda- 
tion of the eye in the effort to see. Its development is still further 
encouraged by the hours of constant daily application in reading and 
writing at that period in life when the tissues are plastic and easily 
molded. 



CONSEEVATIOX OF VISIOJ^. 45 

There are two obvious and logical remedies: (1) Relieve the ex- 
cessive focal strain of the astigmatism or other abnormal refractive 
condition by suitable glasses. (2) Conduct school studies in such 
a way that close work on books or with pencil and pen is abandoned 
or reduced to such limited references as would seen to be absolutely 
necessary. 

We are destroying the eye5 of a large number of school children 
by the burden of continuous near work to which the}^ are subjected. 
At the first appearance of beginning shortsightedness these children 
should be segregated from the others in special classes in which they 
are taught without books. Measures may be employed for sucJi 
children in which the building up of the brain, the training of the 
mind in clear, accurate, and quick thinking, the government of the 
will, and the development of all of those faculties which we consider 
to constitute the education of the individual can be accomplished at 
least as effectively, as rapidl3% and as certainly with a far less depend- 
ence upon the printed page than has heretofore been considered 
necessary. In other words, let us have more thinking and fewer 
books. 



B. SCHOOL LIGHTING. 

James Keer, M. D.. London, England. 

Ocular experience is the onlj- final test of illumination. Eye- 
strain is due to fatigue from overwork or glare. The eye adapts 
itself to brightness by varying its sensitiveness. Primary glare is 
due to physical effects on the retina, secondary glare to difiiculty in 
adaptation. One-third of our elementary school children have 
such defective visual acuity that better illumination is necessary 
than for normal eyes. 

Advances in photometry have made measurement of illumination 
convenient. Relative photometry in terms of outer daylight is the 
best for school work. The minimum for any school place should 
be raised to double Cohn's demand of 10-meter candles. JavaFs 
measurement of sky visible from any place is facilitated by solid 
angle gauges. The effects of reflection from walls are of impor- 
tance; cross lighting and top lighting are also advantageous; but 
accessory illuminating devices require caution. 

Artificial lighting for each school place should be not less than 
2-foot candles. Blackboards require 60 per cent more. Glare must 
be guarded against. There should be indirect lighting, soft and 
shadowless, for halls, semi-indirect and local direct for fine work. 
The use of gas and electricity is not likely to be decided on hygienic 
grounds alone. 



46 SCHOOL HYGIENE. 

C. DEFECTIVE VISION FROM THE ECONOMIC STANDPOINT. 

Le\yis C. AYessels, M. D., 
Bureau of Health, PliUaOelphia, Pa. 

Ill Philadelphia each pupil costs about $35 per year to teach. 
Under normal conditions a pupil 14 years old should reach the eighth 
grade at a cost to the State of $280. If on account of defective vision 
the child only reaches the fourth grade in that time it has still cost 
the State $280, but with only $140 worth of result, a loss to the State 
of $140. The loss to the child is considerably more, because at the 
age of 14 it is likely to be put to work, poorly equipped for the strug- 
gle for existence, its earning power curtailed for the want of an 
education, so that it can contribute but little toward its own support, 
that of its family, or that of the State. So again the State loses, 
and all for the want of suitable glasses. While it is quite easy for 
the medical inspector or teacher to detect defective vision, the recom- 
mendation for glasses can not always be carried ou.t on account of 
poverty or ignorance. These cases can procure free treatment at the 
dispensaries, but they are too poor or too indifferent to buy the glasses 
prescribed, and so they continue to struggle along greatly handi- 
capped and fall behind on account of their eyes. 

The department of public health and charities has solved this prob- 
lem in Philadelphia by establishing a division of ophthalmology 
under the bureau of health, where poor children can be refracted and 
furnished with glasses free. We are now refracting nearly 2,500 
cases a year. If we save each one of these children but one year 
during its entire school life there will be. an annual saving of over 
$87,000, not counting the chikrs time and its increased efficiency. So 
the furnishing of free glasses to school children is not a charity per 
se, but is a duty and an economic problem. Many children have 
come to the dispensary wearing glasses bought from some refracting 
optician or from a 5 or 10 cent store. These glasses were not only 
unsuitable, but they were positively injurious to the child's eyes. 

Few children remain in school after the age of 14, the legal age at 
which children are permitted to work. This fact emphasizes the 
necessity of examining the eyes of children in the kindergarten and 
the first grades. Municipalities should establish their own eye dis- 
pensaries for the refracting and the furnishing of glasses free to poor 
pupils at least. This is an economic problem rather than a charity, 
as it reduces the cost of education and at the same time increases the 
efliciency of both the pupil and the teacher. 



SCHOOL HYGIENE. 47 

VII. SCHOOL FEEDING. 



A. HISTORY AND PRESENT STATUS OF THE MOVEMENT. 

LoxJTSE Stevens Bryant, Vuiversity of Pennsylvania. 

The school-feeding movement is a part of the larger provision for 
the child's physical needs, which has grown out of the realization of 
the dependence of mental progress on bodily condition. It includes 
first the btud}^ of the child's nutritional condition, and then the prac- 
tical question of providing food at school. As a rule, the term is 
narrowed to include the provision of warm meals, either breakfast 
or lunch, at a small sum covering the cost of the food, and its prepa- 
ration and service. 

Considered externally, the movement is qttite old, as its beginning 
antedated compulsory education in Germany, and was associated 
with the first constructive attempt on the part of municipalities to 
meet the social needs growing out of the industrial revoltttion at the 
end of the eighteenth century. 

In the ntain, the workers in the school-lunch movement in Amer- 
ica are convinced that if the school is to assume responsibility for the 
feeding of the children, it must be becattse of the conviction that 
warm, nourishing meals, served at cost, are a benefit to 100 per cent 
and are not merely temporary remedies for acute distress among the^ 
10 per cent that are acutely undernourished. 

Five years ago there were four cities with lunch experiments imder 
way in the elementary schools. There are now something over 70 
cities with lunches in the regular elementary schools. In nearly all 
of these the school board assumes at least part of the responsibility.. 
In an increasing number it assumes entire responsibility. Lunches 
are provided as a regular part of the equipment in nearly all the 
open-air schools, which are now open in over 100 cities, while the 
high-school lunch is provided as a matter of course. 

Wherever the school feeding movement develops, two things hap- 
pen : First, in all countries, school feeding — begun by private 
philanthropy as a relief measure, or by a semiofficial attempt to 
encourage school attendance, or in some cases to make it possible — 
becomes gradually recognized, first b}^ municipalities and then by 
States, as a legitimate extension of the principle of compidsory edu- 
cation; second, as soon as the State begins to take part in the pro- 
vision of food for its children the meals lose the character of relief 
measures and become factors in education. Avith the double result 
that the suitability of the dietaries is considered with far more care 
than before, and the hygienic and esthetic aspects of the service 
receive attention. 

13011°— 13 4 



48 SCHOOL HYGIENE. 

The greatest need of the school-lunch movement is not propa- 
ganda — it is going forward with its own momentum. What is needed 
is the development of technique in medical examinations and in 
dietetic plans; the application of the principles of efficiency to the 
administrative system; and finally the constant extension of scien- 
tific experimentation in this field, which affords an unrivaled op- 
portunity for the development of the science of nutrition. 



B. THE NUTRITION OF SCHOOL CHILDREN. 

Ira S. Wile, New York, N. Y. 

If we approach the problem of school lunclies and medical inspec- 
tion with a consciousness that they are interdependent and cooperat- 
ing to secure the same end, we shall better appreciate their educational 
importance. Both are designed to act in a preventive and curative 
wa}' in all phases of physical and mental health. Medical inspection 
seeks in part to eliminate contagious diseases from the public schools, 
while school lunches aim to increase the resistance of children to 
contagious diseases. Medical inspection seeks out physical and mental 
defects; school lunches aim to prevent or relieve physical or mental 
defects. The common ground of school lunches and medical inspec- 
tion might well be said to be the prevention, determination, and 
■relief of malnutrition. During the early years of school life nutri- 
tion may suffer, owing to incorrect adjustments to school life. A 
late and hurried breakfast or a rush to school without any food, 
followed later by a bolted lunch, may be manifested in loss of weight 
and supervening pallor. 

It is most striking that lunches are now being supplied for curative 
purposes to crippled, anemic, tubercular, and other subnormal chil- 
dren after the medical inspector has called attention to the physical 
deterioration of the children. These efforts to better nutrition have 
been accompanied by a reduction in physical and mental defects, 
together with a marked advancement in mental and moral progress. 
It is all well and good to supply abnormial children with food and 
fresh air, as well as mental pabulum, but it seems more rational to 
give the same opportunity for the preservation of health to the nor- 
mal children instead of placing a premium upon ill health. In every 
community there are man}^ poorly fed children, the inadequacy of 
whose diet is shown in part in anemia, underweight, enlarged glands, 
and similar s3^mptoms. Malnutrition is a factor, though, to be sure, 
not the only one, in the etiology of tuberculosis, adenitis (enlarged 
glands), anemia, defects in vision, mental defects, chorea (St. Vitus's 
Dance), protracted convalescence from diseases, and impaired re- 
sistance to infections. A second factor in malnutrition to which in- 



SCHOOL FEEDING. 49 

sufficient attention has been given is the effect of undernourishment 
before a child's entrance upon schooL The relative starvation in 
protein, lime, iron, calcium, and magnesium during the first five 
years of life helps to produce the child suffering from malnutrition 
upon entrance to the public school. The report of the medical in- 
spector, however, will probably class such a child as belonging to 
the group Avith such ph^^sical defects as enlarged tonsils, anemia, or 
enlarged glands. 

The purpose of school lunches is not to relieve acute hunger, but 
to relieve chronic underfeeding. Dr. McMillan, of Chicago, found 
15.9 per cent kindergarten children physically below par, and esti- 
mated that underfeeding was the cause of 11 per cent in kinder- 
gartens and 7.8 per cent in other grades. Dr. McKenzie regards 
one-third of all the school children in Edinburgh as poorly nour- 
ished. Dr. Francis Warner and Hack Tuke found 28.5 per cent of 
London school children suffering from deficient feeding. The Xew 
York committee on the physical welfare of school children in 1907 
declared 13 per cent of 990 children examined to be suffering from 
malnutrition, and Dr. Sill in 1909 estimated that 40 per cent of the 
children in the elementary schools of Xew York City were ^Doorly 
nourished. The Xew York school lunch committee in 1910, in an 
examination of 2,150 children, adjudged 13 per cent to be marked 
cases of malnutrition. In Chicago, in 1908, of over 10,000 children 
examined, 12 per cent were reported as suffering from malnutrition. 
In Boston, in 1909. underfeeding was found in 16 per cent of over 
5,000 children. In Philadelphia 24 per cent of 500 children exam- 
ined were found to be suffering from underfeeding. In St. Paul, 
in 1910, 20 per cent of 3,200 children in schools in the poorer dis- 
tricts were reported as manifesting the evidences of marked under- 
feeding. 

Regardless of the primary factor in malnutrition, whether it be 
due to a deteriorative reaction against an oppressive physical en- 
vironment, to unhj^gienic home conditions, or to lack of adequate 
or sufficient food, no inspection card should be regarded as complete 
without some notation regarding the state of nutrition. This po- 
sition is strengthened by the comment of the chief medical inspector 
of London (1910) : 

It is certain that maluutrition aud physical defects are closely associated 
ana react iiix)n each other, but it is diflBcult to determine their exact relation 
to each child or to say in what degree malnutrition causes the other physical 
evils. Merely to increase the supply of food would in many cases not solve 
the complex problem of the individual child, although in many cases lack of focKl 
lies at the root of the mischief. 

The relation between nutrition and medical inspection is patent. 
Medical inspection should be so thorough as to indicate not merely 



60 SCHOOL HYGIEXE. 

the names of various syiiiptonis and conditions, but should suggest 
whether or not mahiutrition could possibly be an underlying factor. 
Under such conditions school lunches could serve in a remedial way 
b}^ raising the standard of nutrition. Frequently medical inspections 
reveal some children not possessing marked defects, but who are 
very .close to the health-poverty line, and for them school lunches 
could be instituted for prophylactic purposes. Most civilized coun- 
tries have already installed the school lunch as a natural and normal 
lydvt of an educational movement, Avithout laying unnecessary stress 
upon its value as a health measure. As medical inspections are 
regarded as advantageous to the school system through the lessening 
of disease and the improvement of the mental caliber of the children, 
careful attention to nutrition may supph^ a -valuable means of in- 
creasing mental activity and building up the physical health of our 
school children. 



C. TEACHING NUTRITION VALUES THROUGH PENNY LUNCHES. 

Mabel H. Kittredge, 
Xetc YorJc School Lunch Committee. 

In a list of causes of malnutrition I notice that in England pov- 
erty is put first, but it seems to me in this country ignorance comes 
first, and this ignorance can not be conquered hj ladling out a penny's 
Avorth of soup and tempting children to buy graham crackers and 
rice pudding and fruit from a penny table. The general raising of 
standards will, of necessity, be slow, but are we doing all we can to 
change the habits of the families of the children who buy luncheons 
from us? Take, for example, the habit of setting the table at home 
and having no regular time for meals. This habit among many of our 
immigrants comes from, the confusion of living. The school hour at 
noon does not fit into the husband's hour off, little children demand 
food more frequenth^ than their elders, the rooms are small and over- 
crowded, and after a time it seems too much trouble to set the table. 

Every child in our scliools sliould be taught that health is only 
possible with regular meals ; not taught it once, but repeatedly. Every 
mother, through mothers' meetings or by circulars printed in her 
ow]i lansriiage. should be made to understand that the school lunch 
is simply one way to make more possible regular hot meals for her 
children; that we are not feeding her children because of poverty, 
but because Ave realize the confusion of conditions that she is obliged 
to meet: and, incidentally, that if she does not giA-e her child at least 
3 cents a daA^ for his lunch she has not done her part. 

But even before Ave get our universally ideal educational system, I 
believe Ave who are serving luncheons can do a great deal more than 



SEX HYGIENE. 51 

we are doing. For example, in New York next year we are to serve 
a noon meal in 17 elementary schools. We estimate that we shall 
feed 5,000 children a day. If these 5,000 know each day the name of 
the soup they have eaten and go home and tell their mothers about it, 
something will have been done. Can not we have on the classroom 
blackboard the ingredients used in the soup, and, possibly, a short 
explanation of their food value, showing, for example, the food value 
of a bean soup over a candied apple, both being the same price, and 
the latter very popular ? It would make the lunch much more inter- 
esting, and children do care whether they are strong and big or not. 
The boy would like to get his money's worth from the penny table. 
When he saw on the blackboard that the penny he spent to-day for 
rice pudding gave him four times as much good, growing, running, 
fighting stuff as the penny he spent yesterday for a sweet cake, it 
would arouse something in him that would be one step toward better 
health for that bov. 



VIII. SEX HYGIENE. 



A. PUBLIC OPINION AND SEX HYGIENE. 

Charles W. Eliot. Harvard University. 

During my somewhat recent active life I have never seen such a 
change of public opinion among thoughtful people as has taken place 
among them within the last 10 years on tlie subject of sex hygiene, 
using that term in its broadest sense. The policy of silence on all the 
functions and relations of sex, whether normal or morbid, was almost 
universally accepted for centuries by physicians and clergymen, and 
in family life. In the Protestant denominations of the Christian 
church the normal processes of procreation and birth were associated 
with the supposed fall of man and his total depravity. In the 
Catholic Church the offices of a priest were necessary for the mother 
and new-born infant by way of purification; and the perversions of 
the sexual passion were to be dealt with onl}^ by the priest in the con- 
fessional. The miserable victims of the venereal diseases Avere excluded 
from all hospitals and dispensaries, or were treated by compassionate 
physicians only by stealth. Venereal diseases were regarded ex- 
clusively as diseases of sin and shame until their frequent communi- 
cation to wholly innocent persons had been demonstrated within 
recent years. 

Certain rather recent medical discoveries have contributed to the 
extraordinary change in public opinion. When blindness was traced 
to gonorrhea in the mother, a potent cause of the croAvding of blind 



62 SCHOOL HYGIENE. 

asylums was thus brought to light. Insanity and general paresis 
were in many cases traced back to syphilis, and an explanation was 
thus given of the increase of insanity in civilized communities. It 
became known to the medical profession, and later to many unprofes- 
sional persons, that the consequences of gonorrhea were almost as bad 
as those of syphilis in regard to the infection of innocent persons and 
the destruction of family happiness. Quite recently a treatment for 
syphilis has been discovered which has proved satisfactory in many 
thousands of cases, although the permanence of the cure can not yet 
be confidently affirmed, and it has been proved that by persistent 
treatment gonorrhea can apparently be permanently cured in a large 
proportion of cases. 

In obscure disorders the Wassermann t^st^foi* syphilis gives the 
phj'sician, who is trying to make the diagnosis, on the one hand a 
strong indication of the presence of a serious complication, or on the 
other of its absence. As a guide to treatment either determination is 
invaluable. The same test can supply evidence that a cure has been 
effected. It will also probably furnish in time trustworthy statistics 
concerning the prevalence of syphilis in the community at large, 
statistics greatly needed, because the previous guesses and estimates 
on that subject and the results of some recent applications of the test 
to considerable numbers of public hospital pati-ents are disquieting. 

These medical discoveries raise important ethical questions. Yfill 
the fact that syphilis can apparently be cured in many instances 
increase sexual immorality? Will the fact tliat a few dissolute men 
and women escape venereal diseases, and the further fact that there 
are antiseptic precautions which diminish somewhat the dangers of 
licentiousness make young men readier to encounter the dangers of 
sin? These are questions which only experience can fully answer. 

Public opinion has been moved strongly toward the subject of sex 
hygiene, because of the many signs of physical deterioration among 
the civilized nations, which suffer from the eager rush out of the 
country into the city, from the factory system, and from alcoholism 
and the sexual vices. ]Many thoughtful persons are anxious about 
the diminishing size of voung men at the age of admission to the 
national armies^, the rapid reduction within 50 years of the size of 
the average family, the common inability of women to nurse tlieir 
babies, the terrible infant mortality in cities, the alleged increasing- 
number of physically or mentally defective children, and the increas- 
ing proportion in civilized communities of persons — ^young, mature, 
or old — who are practically unable to earn their livelihood. The 
humanitarian policies in regard to the treatment of the defective, the 
incompetent, and the criminal classes seem to tend to increase the 
burdens carried by the normal and industrious portion of the popu- 
lation, and these burdens react on the vigor and happiness of the 



SEX HYGIEjSTE. 53 

normal people. The increase of liberty for all classes of the commu- 
nity seems to promote the rapid breeding of the defective, irrespon- 
sible, and vicious. 

The new interest in sex hygiene is not due, hoAvever, only to specu- 
lations on the durability of modern civilization or on that of the 
white race. Political philosophers and biologists naturally take a 
strong interest in these large problems, but the individual young 
man or woman has a narrower sentiment on this subject, though one 
quite as intense. The young people have lately heard for the first 
time what the risks of marriage are; what the physical enemies of 
happy family life are; how the different standard of chastity for 
men and women has worked during the slow development of the 
society now called civilized. With these young people the problem 
becomes an intensely personal one. " How can I best regulate my 
own conduct in order to win the normal satisfactions of family life ? 
How can I be protected from the ignorance or sinfulness of asso- 
ciates? In short, how can I steer a safe course through the swirls 
and tumults of the sexual passion, which seems to be a principal 
source not only of the normal satisfactions and delights of human 
life, but also of its worst anxieties and afflictions?" Intelligent 
fathers and mothers feel a new sort of duty toward their children, 
the duty of protecting them from vicious allurements and giving 
them in due time knowledge of good and evil in sex relations. 
Teachers in public schools see before them a deplorable proportion 
of children who have bad inheritances, both phj^sical and mental, and 
who live in bad environments; and, sharing the new freedom in the 
discussion of social problems, they are eager to be told how they 
can contribute to the arrest and prevention of these miserable tenden- 
cies. Churches are taking a new interest in the questions which 
arise out of unhappy marriage and easy divorce. Many persons who 
get a smattering on eugenics are eager for legislation to make mar- 
riage conditional on bodily and mental health and to keep in con- 
finement the feeble-minded, the alcoholic, and the insane, not only 
till they are of age, but till they are incapable of breeding their 
lil^e. Some knowledge of social hygiene and eugenics has led many 
persons to advocate hastily prepared legislation as a panacea for 
evils which terribly afflict modern communities, and yet are very 
ancient. Such is the genesis and such the immediate outcome of the 
new and widespread interest in sex hygiene. 

The most important question before us is the question, " What 
forces can now be put in play against the formidable evils which 
gravely threaten family life, human happiness, civilization in general, 
and the very life of the race ? " Something must be done. Chris- 
tianity, democracy, and humanitarianism have all failed thus far to 
cope with these evils which are sapping the vitality of civilized 



64 SCHOOL HYGIENE. 

society. What can be done? It is clear that no one force or agency 
is to be exclusively relied on. All the uplifting forces of society 
must be simultaneously enlisted in this cause — state, church, school, 
college, industrial, and charitable corporations, all productive indus- 
tries, and both preventive and remedial medicine. The attack must 
be directed against the three principal causes of the present evil con- 
ditions: First, against lust in men; secondly, against the weakness, 
dependence, mental deficiency, and lack of moral principle of the 
women who supply the demands of men; thirdly, against the greed 
and depravity of the wretches who maintain a profitable commerce 
out of this licentious demand and suppl3^ 

The struggle against lust in men must bring into play a variety of 
defensive agencies, such as full occupation for 43ody and mind, manly 
sports, ambition and energy in the earning of a livelihood, timely 
knowledge of the good and the evil in sex relations, temperance in 
both food and drink, and deliverances from mischievous transmitted 
beliefs, such as belief in the harmlessness of gonorrhea or in the 
necessity of sexual indulgence for the maintenance of health and 
vigor in men. For the giving of the information which all young 
men need, a variety of agencies must be utilized. The best source of 
the information which the young man needs is the parent, the mother 
in childhood, the father later ; but inasmuch as many parents are too 
ignorant to give this information, it is indispensable that schools, 
churches, Christian associations, and the various kinds of clubs main- 
tained for good social purposes should all l^e utilized. The public 
l^ress, too, or that part of it which has moral purposes and a sense 
of responsibility, must lend its aid, and the policy of silence must be 
abandoned in favor of a policy of high-minded and reserved exposi- 
tion. It must be made impossible for either young men or young 
women to plead ignorance as their excuse when they fall into moral 
and physical degradation. 

The second attack must be directed against the lack of moral and 
mental stamina in girls and young Avomen whose inheritances have 
been low and Avhose environment has been dull and miserable. Pros- 
titution is voluntarily resorted to by some responsible women Avhose 
propensities are naturally bad, but the great majorit}^ of prostitutes 
are physical, m^ental, or moral defectives in the strict sense of that 
word. It is to the interest of all such defectives and of society at large 
that they be first discovered in their families or at school or in the 
churches or social settlements or in hospitals and infirmaries, and then 
segregated and confined under wholesome conditions where they 
can not be seduced to a vile life nor be abandoned even for an hour 
to their own imperfect self-control. Here is a great service that the 
public schools can render to society, and here lies a strong argument 
in favor of the extension of attendance at school bevond the age of 13 



SEX HYGIEXE. 55 

or 14, Tvhich is now the limit of school life for a great majorit}^ of 
American childrei:. Family, school, church, and all good social 
organizations should steadily contend against indolence, love of ex- 
citement, self-indii'gence, and luxurious tendencies in girls; should 
prCA'ent the deprcs^^ion or jojdessness of extreme poverty : and should 
provide and cultivate systematically both helpful work and health- 
fu] play for all soi ts of girls and young Avomen. 

The third assni-lt which society should make against licentiousness 
may be undertaken with prompt decision and with expectation of 
effecting rapid improA^ement. This is the assault on commercialized 
A'ice. There need be no hesitation in attacking with all the powers 
of the hnv the men and women who pander to men by seducing or 
compelling young women to the horrible existence of the prostitute, 
owned or leased by a dealer in the gratification of lust, and provide 
shelter and facilities for the worst of human vices. In that shame- 
ful business much intelligence and shreAvdness and much capital are 
employed and much money is made. Some of the moneA^ made is 
freely used to secure immunity, or periods of immunity, from prosecu- 
tion in the courts. This iniquitous commerce should be put an end to 
by Adgorous action under existing laws. No third party should be 
allowed to make an}^ profit out of licentiousness. No brokers or 
commission merchants in A^ce should be allowed to exist in a civilized 
community, and no owner of real estate should be alloAved to use it 
himself, or lease it to others, for immoral purposes. But one may say, 
" The segregation and regulation of brothels are policies which haA'e 
come doAvn through unnumbered centuries in many nations and 
under all the great religions of the world. Are we to attempt the 
uprooting of such ancient policies of toleration and license? '' I 
ansAver, '' Yes ; Ave are ; " because those ancient policies have every- 
where failed to protect the human race from evils which in the long 
run Avill work its destruction. Former generations Avere not sure of 
that failure. This generation knoAvs it. Former generations had 
no adequate means of contending against the diseases Avhich in the 
human race accompany the perversions and excesses of the sex 
instincts. AVe possess these means. Earlier generations had not 
appropriated the idea of gOA^ernment of the people, for the people, 
and by the people. For us the interests of the mass oA^erride the 
interests of the indiA^idual, particularly when the alleged interests of 
the indiA'idual are corrupting and degrading. 

The interest of many thinking people in the subject of eugenics is 
closely allied to interest in sex hygiene, but zeal for Avise breeding is 
apparently leading to some hasty or ill-considered legislation. The 
existing legislation to limit selection in marriage is evidence of a 
Avise recognition of the dangers in continuing stocks burdened Avith 
inheritable Aveaknesses. and is so far Avelcome: but not all the pro- 



56 SCHOOL HYGIENE. 

posed prohibitions can be justified by biological science at its present 
stage. The educated public have much to learn with regard to the 
proper mating of persons who have some nervous defect. Such per- 
sons should mate with those whose ancestry has no such defect. 
Although it is undesirable that feeble-minded, epileptic, or insane 
persons should have children, yet if such a person mates wisely, and 
the children of such a union again mate wisely, the progeny of the 
third generation will probably be quite as free from nervous defect 
as the general population is. Again, the reproduction of the feeble- 
miniied will not necessarily be diminished by laws which prevent 
them from marrying. Such persons ordinarily have very little self- 
control, and, if left free, will have children whether married or not. 
The laws against undesirable marriages need-to be revised in most 
of the American States, and the public needs to be convinced that 
no such law can eradicate the evil. Nothing but the compulsory 
seclusion of all defectives under humane housing, training, and labor 
conditions will accomplish the eugenic object of the community. 
Laws which provide that candidates for marriage must be free from 
syphilis or gonorrhea do good, provided that proper provision be 
made for the certificate to that effect from a trustworthy physician 
appointed by the State. The appointment for this duty for an ade- 
quate number of physicians by the State boards of health would give 
a new and important function to these boards. The maintenance of 
such a staff, furnished with all the means of applying adequate tests 
in doubtful cases, would be somewhat expensive; but this expense 
might perhaps be covered in part by a moderate addition to the fee 
for a marriage license. Each physician would probably require the 
aid of a man and a woman competent to inquire into the family his- 
tories of the applicants for a marriage license. 

It is probable that much public instruction will have to be given 
through newspapers, magazines, lectures, and discussions in men's 
clubs and women's clubs before sound and effective eugenic legisla- 
tion can be placed on the statute books. Again, we find that public 
progress in relation to sex hygiene and eugenics is to be procured 
chiefly through educational methods. It is therefore of the utmost 
importance that the processes adopted for diffusing sound knowledge 
about the normal and the morbid sex relations, the dangers of licen- 
tiousness, safe mating with a view to healthy progeny, the prevention 
of the reproduction of defectives, the destruction of commerce in 
vice, and the prevention of venereal contagions, should all be carried 
on plainly, but delicately, without exaggeration or morbid sugges- 
tion, without interference with parental rights or religious convic- 
tions, and in general in a pure, high-minded, disinterested way. The 
pioneering part of this work must be done by voluntary associations, 
as is usual in social reforms; but it should be the constant aim of 



SEX HYGIENE. 57 

these private organizations to enlist gradually the public authorities 
in this vast undertaking and to transfer to the public treasury hh 
fast as possible the support of all those parts of the work which 
experience proves to be of sure and permanent public advantage. 
The pioneering in regard to both research and practical measures 
will probably continue for many years to be the work of voluntary 
associations. 



B. THE SOCIAL EMERGENCY. 

William T. Foster, 
President Reed College. Oregon. 

The social emergency that confronts the human race is flaunted be- 
fore us in many unlovely forms and appears in nevv^ aspects wherever 
we scratch beneath the surface. Study the results of human frailty 
and the possibilities of racial betterment through any avenue of ap- 
proach, and we meet the fundamental problems of sexual hygiene and 
morals. Our cities struggle in vain to free their police forces from 
graft, while the business of prostitution offers such large and easy 
j)rofits. Students of municipal recreation centers discover such con- 
ditions that they regard parks and playgrounds as physical and 
moral menaces unless under careful and trained supervision. 

The home, the church, and the school have reached a small pro- 
portion of the human race with adequate sex instruction, while 
thousands of quack doctors still ply their vicious trade, widely dissem- 
inating falsehoods, and preying upon that fatal ignorance of vital 
matters that we have carefidly cultivated in our children under the 
name of innocence. The juvenile courts bring in their daily records 
of pitiful cases. The antisaloon workers present sad evidence of the 
dependence of commercialized prostitution on the liquor traffic. 
Decent employers of labor cry out against the competition with em- 
ployers who expect their young women to eke out a living wage by 
immoral conduct. Honest keepers of hotels and lodging houses pro- 
test that it is useless to keep up the fight for decency while disrepu- 
table houses under police protection make exorbitant profits. Stu- 
dents of eugenics find sextial immorality the chief hindrance to racial 
improvement. Turn where we may within any field of legitimate 
human endeavor and we run counter to this destructiA^e force: we 
discern new aspects of the social emergency. 

In the fact of this social emergency, there are but few who offer 
no complaint. They are the white slavers, the pimps and the pan- 
derers, the imbeciles and feeble-minded among their victims, the 
keepers of bawdy houses, the " respectable " owners of property used 
to promote the joint business of drunkenness and prostitution, dealers 



58 SCHOOL HYGIENE. 

in liquor, municipal officers and police avIio protect vice for a living, 
fake doctors who thrive on ignorance and spread disease, and iieAvs- 
papers that make such criminal business possible through advertise- 
ments accepted at extraordinary rates. 

To begin with, there is the historj^ of the question. Many genera- 
tions have joined in the " conspiracy of silence " in matters pertain- 
ing to sex and reproduction. The result is widespread ignorance 
of matters of the utmost importance- to the individual and the race, 
ignorance of which many good people are proud. During these 
generations in which the home, the church, and the school have with- 
held the truth from 3'oung people, other agencies have been busy 
disseminating falsehoods. Having almost no opportunity to hear 
sex and matrimony discussed with reverence,^x»ur young people have 
almost invariably heard these subjects discussed with vulgarity. 
Partly as a result of all this has come the general acceptance of the 
double standard of morality which has bitterly condemned the girl — 
made her an outcast of society — and excused the boy for the same 
offense on the specious plea of physiological necessity. With the 
sanction of this double standard, tacitly accepted by society, the 
majority of men have grown up in indulgence and have developed 
habits which are, or which they believe to be, beyond their control. 
Millions of men who recognize no law in sex life but their own ap- 
petites are thus contributed to us by the past. They are factors in 
the present situation and must be reckoned with. 

As a matter of fact the educational phases of social reform are 
of most immediate importance. Nothing can so profitably occupy 
the attention of social hygiene societie>s as the education of the public. 
If groups of social workers come to serious disagi-eement on other 
phases of the present emergency; if the discussion of restricted dis- 
tricts, minimum wage laws, health certificates for marriage, and 
reporting of disease divides the group into warring camps; all can 
unite in favor of spreading certain truths as widely as possible; 
and it is not difficult to agree on at least a few of the many methods 
Avhich have alreadj^ proved effective in educational campaigns. 

At the outset of our attempt to educate the general public in mat- 
ters of sex, we face certain factors v\hich govern the scope, time, 
place, and method of any successful efforts. Failure to gi^^e these 
factors due consideration has brought man}^ attempts to early and 
unhappy ends, and convinced some people that ignorance is safer 
than such education. 

No aspects are more imj)ortant than those concerning morals and 
religion. The restraining fear of disease may and probably will 
be thrown off b}^ science. AMiether education in scientific aspects of 
the subject will do good or harm in a given case depends on the extent 
to which moral and religious ideals control the conduct of the indi- 



SEX HYGIENE. 59 

vidiial. The inadequacy of mere information in matters of sex is 
painfully evident. To the knowledge of what is right must be 
added the will to do the right. All the other aspects of the social 
emergency treated with superhuman wisdom would still leave the 
greatest problem unsolved. As moral and religious instruction is 
the dominant educational need of the present generation, so the 
moral and religious aspects of sex problems transcend all the others 
in importance. 

These are the most important phases of the social emergency. It is 
difficult to see them in all their intricate relationships and to realize 
that in any one approach we touch only one side of a many-sided 
problem. The great majority of our people see only the superficial 
aspects or see one particular phase in distorted perspective because 
that is brought close to them through a special case of misfortune. 
Even social workers are in danger of narrowness of vision because 
of devoted service in particular fields. To attempt to deal with sex 
aspects of school hygiene, as though these problem.s were distinct 
from other phases of the social emergency, is to invite failure from 
the start. The union of the American Federation for Sex Hygiene 
and the American Vigilance Association is a step in the right direc- 
tion, for it gives promise of seeing the social emergency clearly and 
seeing it whole.^ 



C. EDUCATION v, PUNISHMENT AS A REMEDY FOR SOCIAL EVILS. 

Hugh Cabot, M. D., 
President American Socictu of GenUo-L'rinary Surgeons, Boston, Mass. 

Boys have, in general, been given no systematic training or in- 
struction in the nature of their sexual make-up. But if the boy's 
equipment was not cared for by education, it was not neglected by 
nature. Natural curiosity and intense sexual cravings attend sexual 
maturity, and its phenomena are often rather terrifying to the unin- 
formed. To fall into error is what might naturally be expected of 
ignorance facing the unknown. Again, at the period vrhen active 
growth is over, the young man will not infrequently be driven by 
his sexual self to an extent almost incompatible with efficient living 
(of course assuming that he is not married). His instruction is 
likely to be at the hands of ignorant contemporaries in the form of 
misstated fact or direct lie. 

The girl has been given even less information. Our attitude has 
been, '" Don't ask." Her religious teaching has laid stress upon the 
sanctity of marriage, but she was not taught what the marriage rela- 

1 The two organizations were amalgamated at the Buffalo meeting. 



60 SCHOOL HYGIENE. 

tion is. Like the boy, she picked up a certain amount of misinforma- 
tion. 

Sncli was the equipment of the younger generation. It taught 
asceticism, not chastity, before marriage, and after marriage a licen- 
tious sexual life, limited only by its compatibility with human ex- 
istence. And this standard we proposed to enforce by punishment. 

The boy, follow^ing his instinct, often became infected with vene- 
real disease. Fearing to go to parents, and lacking money,. he fell 
into the hands of quacks, with resulting complications and uncured 
and chronic disease. The boy of stronger character adopted asceti- 
cism, and, not understanding the storms of his nature, in his turn 
fell into the hands of the quack, and was drained of money, health, 
and at times almost of reason. 

The girl was denied her natural defense, that of comprehension, 
and. when the defense of a guarded life was lax or absent, yielded 
to she knew not what. Pregnancy, abortion, prostitution, venereal 
disease were among the natural results; the last, if possible, more 
serious in her than in the boy. 

The plan of dealing with the sex question during the past half 
century has not, I think, met with much success, and the continuance 
of this method will meet with even less success in the future. The 
dangers arising from the mismanagement of the sex instinct are in- 
creasing. Control by punishment, which has failed in the past, is 
necessarily doomed to more tragic failure in the future. Punish- 
ment dealt out as we have dealt it is concealment, lying; concealment 
and lying undermine character ; and the wonder is not that character 
is less firm and robust than we desire, but that any firmness or vigor 
exists at alL 

If we are to stand any chance of success, it will be upon a basis of 
intellectual comprehension and by the deliberate strengthening of 
the personal defenses of the individual which enable him to guide 
successfully his own life. Dependence upon an abiding faith, based 
upon accepted dogma, is not suited to the spirit of the times. Faith 
has waned; can it be because we have been faithless? We have lied, 
and the failure of faith is the dividend paid for our untruthfulness. 

To secure comprehension^ a thing far more fundamental than 
knowledge, instruction must be given early, must be continuous and 
progressive. It must teach clearly and honestly the true nature and 
effects of the sex instinct. Instruction leading to comprehension will 
require men and women of unusual breadth and strength of char- 
acter, but I believe that no other form of education is more likely to 
produce profound and lasting influence upon national character. 
This teaching must not be in isolated form. We must guard against 
the ever-present danger of bringing people, old as well as young, to 
regard sexual morality as different and removed from other forms of 



SEX HYGIENE. 61 

morality. We must so plan our instruction as clearly to relate this 
form of morality to truth, honor, courage, virility. 

Sooner or later we shall come to realize that teaching the compre- 
hension of the sex instinct is the function of the public school, though 
we are far from such a realization to-day. We still cling to the idea 
that this instruction can be given in the home, forgetting that a large 
proportion of parents are not equipped, either by nature or art, to 
give this instruction. If we depend upon the home as the source of 
teaching, that teaching will not be given. 



D. POINTS OF ATTACK IN SEX EDUCATION. 

Thomas W. Balliet, New York Uni-s'ersity, 

As a matter of wise public policy and as a means of accomplishing 
ultimately the greatest good, sex education should begin where its 
necessit}^ and practicability are universal^ recognized and where 
mistakes during its experimental stage will be much less serious than 
in the case of such instruction to young children in school. 

Accordingly, the first point of attack should be the parent. No 
one questions the possibility of doing a vast deal of good by en- 
lightening fathers and mothers on this vital subject. Public senti- 
ment is ripe everywhere for this step, and competent persons can be 
found, usually among the medical profession, to give this instruction. 
Furthermore, the proper instruction of parents will be the most 
effective means of creating public sentiment in favor of giving such 
teaching in proper form to children in the schools. 

Another point of attack for which we are ready is the Army and 
Navy. There is no place where such instruction is more needed, and 
its necessity and practical value are not seriously questioned by any- 
one. It should be given entirely at the Government's expense 
and usuall}'^ by men who have had medical training; and it should 
not be given spasmodically, as at present, but systematically and 
thoroughh/, and on a scale large enough to reach ever}^ enlisted man. 

A third point of attack for which we are ready, and which has 
already been quite vigorously begun, is sex instruction in the colleges, 
both for men and Avomen. Such instruction will not only meet the 
personal needs of students, but will equip those who are to become 
teachers in elementary and secondary schools to give it to pupils in 
these schools. 

A fourth class of persons to whom sex instruction can now be 
effectively given are groups of young men and young women in 
Young Men's Christian Associations, Young Women's Christian 
Associations, social settlements, and similar organizations. 



62 SCHOOL HYGIENE. 

E. CHARACTER AND THE SEX PROBLEMc 

Kkiiakd J. TiERXEY, Woodstock College. 

Sex hygiene concerns the eternal destiny of man. the fate of his 
innnortal sonl, as well as his temporal interests. It is not merely a 
pedagogical question. In the last analysis the question concerns the 
abolition of sexual sin. To this end public teaching of sex hygiene 
to school children is now advocated. 

The proposed courses involve two elements, the intellectual and the 
ethical. The former is detailed : the latter vague and purely natural- 
istic. The main result aimed at is knowledge. The appeal is to the 
wrong faculty, the emphasis in the wrong place. Information can 
not keep a man upright. Knowledge is noL moral jDOwer. Precau- 
tion to avoid disease is not virtue. Xo marked improvement in 
morals has followed the bringing to the attention of our college boys 
the dangers of sexual sin. " Damaged Goods " teaches that knowl- 
edge does not protect. William James approaches the same truth 
when he insists that sensuous images must be combated by ideals 
that lie beyond the intellect. As it appears to me, the detailed teach- 
ing of sex hygiene v\'ill even thwart the noble purpose in view. 

The imagination of the child is flighty, the will weak. The first 
sex impulses are psychological. The detailed teaching of sex hygiene 
makes a strong impression on the imagination. Sinful thoughts, 
desires, and convei^ation follow and prelude other crimes which we 
pass over in silence. 

Sex instruction is apt to put forward by some years the time of 
suggestion and temptation. Safety lies in diverting the attention 
from sex details. The tv\-o great natural protections are modesty 
(reserve, if you will) and shame, not prudery. They do not spring 
from dogma and superstition, but are an instinct of nature. Public 
and frequent discussion of sex details will destroy both. Good inten- 
tions will be thus frustrated. 

The foundations of chastity are in elemental character training. 
Sex instruction can not give character; it is not deep and compre- 
hensive enough. Without character, it is as chaff before the. wind. 
The movement, to be successful, must reach to the very elements of 
character. Failure to form the child's soul does not come from the 
difficulty of the task, but from its neglect. But such formation alone 
is sadly inadequate. Life on the highest plane is impossible without 
God and religion, and chastity belongs to life on the highest plane. 

Appeal to religious sentiment in schools has sometimes raised so 
strong a protest that it has had to be discontinued: will not this 
happen if it is introduced into sex lectures? And if not introduced, 
will the lectures not be fruitful of evil ? Be convinced that religion 



SEX HYGIENE. 6'S 

alone will be of lasting benefit in this campaign. God, not hygiene, 
is the supreme need of the hour. 

My convictions are not favorable to your movement in all its 
details. Neither are they adverse. Eliminate the details of sex 
hygiene ; train character, teach that purity is noble and possible ; that 
vice is vile and carries its own punishment; that marriage is inviolate; 
that the family is sacred. Teach boys that their bodies are vessels 
of honor, the habitation of a soul made in the image of God; train 
them to reverence womanhood and to venerate motherhood. Teach 
girls reserve, modesty of manner and dress, purity, and self-sacrifice. 
Carry your campaign further. Purge the press, cleanse the novel, 
elevate the theater, abolish animal dances, frown on coeducation after 
the age of puberty. Labor that all men may realize the great obli- 
gation of life, Avhich is to know God and do His behests. 



F. SOME METHODS OF TEACHING SEX HYGIENE. 

Laura B. Garrett, 
Teacher, Nevj York, V. Y. 

Sex hygiene is not a new subject, nor one of which children have 
never heard. Xormal children are curious about sex as about other 
matters. They should have given them correct ideas and ideals. 
After correct training they will be less curious and do less talking. 
It is not sex, but reproduction of life, that is to be taught them, cor- 
related with other vital interests. 

What seems like filth in their drawings and remarks can be made' 
clean by giving them plainly and honestly the facts they are ready 
to understand. They need a good vocabularj^ to use in seeking infor- 
mation and to dignify their ideas. They need a respectful knowledge 
of the form and appearance of the body, such as may be had by seeing 
the whole body of a bab}^ or by the use of the best pictures or statues. 
The national committee for mental hygiene places sex ignorance as 
a cause of disordered minds. This is especially true of girls who 
worry over some mistake of j^outh, but when properly taught drop 
the burden and live according to new ideals. 

Instructions may be given to groups, preferably of 15 or less. 

Boys and girls may be taught together in elementary work. 
Knowledge as to sex organs and functions is preferably given before 
adolescence, while the child is still largely unconscious of sex. This 
training ought to begin in the homes. In some homes the child is 
told to run away and not talk of such things. In others he hears 
with brutal frankness what he should know, but without the beauty, 
higher ethics, and social values. In others he is told plainly, hon- 
estly, and beautifully what he is ready for as he develops. This is 
13011°— 13 5 



W SCHOOL HYGIENE. 

as it should be. Mistakes will be made, both of omission and of 
actual teaching, but they are now being made. 

Shall the teaching be done by special teachers or shall all teachers 
be trained for it? Boys and girls now learn from each other or 
from older, vilely ignorant people. All teachers know more or less 
of the subject., All teachers ought to be ready to deal with the 
physiological and biological facts and with their ethical significance. 
For older children more specially trained teachers are needed. Par- 
ents and teachers can present ideas in connection with nature study, 
gardening, or out-of-doors tramps as follows: 

Cradles, or preparation for parenthood: The protection of the 
young of plants and animals; seed pods, nests of fishes and birds, 
holes of rabbits and others; the human mother; the cowbird as an 
example of neglect. 

Motherhood : The ovaries of plants ; seeds ; the ovaries and '* spot 
of life " in aninials ; eggs, both deposited in nests and developed 
within the body; the reproduction of the same kind. The care of 
pet animals leads up to the facts of human motherhood. The teacher 
here as everywhere must earnestl3'' and honestly respect the creative 
power of her own body, if she is to eliminate in her pupils the old 
filthy notions. 

Fatherhood: Both in plants and animal reproduction, the dignity 
and beauty of fatherhood must be presented. - The father's part may 
be studied in the families of various pet animals. The breeding of 
poultry and stock teaches about heredity. The value of a well-bred 
male animal can be shown. The application to human heredity can 
easily be made. 

By such teachings children learn the story of inheritance and the 
importance of parenthood, and a new message of pride in re-creative 
power and its proper use may be given to our people. 

Away with secrecy, shame, and darkness, and the doctrine of '* con- 
ceived in sin." Let in honor, respect, and joy in re-creative poAver, to 
express joy. beauty, and blessing to the individual and to others. 



IX. MENTAL HYGIENE OF THE SCHOOL CHILD. 



A. CHILD CLASSIFICATION AND CHILD HYGIENE. 

Arxold Gesell, Yale T'niversity. 

When knowledge is duly classified it becomes scientific. Increas- 
ing efficiency in educational economy calls for a more thoroughgoing 
classification of the raw material and product of our schools — the 
children. 



MEXTAL HYGIENE. 65 

The primary room is the threshold of the school system ; the kinder- 
garten, the vestibnle. Through this educational Ellis Island our 
future citizens pass, and it is a motley stream of incomers. We do 
not ask them to matriculate; we can not deport; we must accept them 
as they are — normal, subnormal, atypical. No one can thoughtfully 
stand in the presence of such a motley assembly without feeling what 
a misfortune it is to subject all of these children to substantially the 
same daily and the same annual treatment. Nor can one feel that a 
periodical medical inspection for medical defects alone meets the 
situation. From the standpoint of sincere, individualized child 
hygiene, what is demanded is a thoroughgoing diagnosis of the 
health and developmental needs of at least every exceptional pri- 
mary child. The primary school is the port of entry; and it is of 
strategic importance for child hygiene. Here most of the special 
t3q3es of children may be recognized and registered. This is child 
classification at source; and it is the first step toward that consecutive, 
biographical supervision of special children which must become the 
policy of child hj^giene. 

Take an ordinary kindergarten and first grade, with a combined 
enrollment of 100 pupils. Among this number we may expect to find 
at least one child feeble-minded (unable, say, to draw a man or a 
house) ; one child who stutters; two or three who seriously lisp; an- 
other extremely anemic; a badly spoilt child; another infantile 
(babyish, a j^ear or tw^o retarded in mental or moral growth), still 
another morally weak. There will be one negative child (passive, 
colorless, phj^sically fi.abby, mentally inert, uncommunicative, pos- 
sessed of a feeble kind of imitation) ; one oversensitive, nervous 
child (with exaggerated sense of failure, overconscientious. lacking 
in humor) ; one superficially precocious child : another distinctly 
superior (eager, ardent, imaginative, sociable). Without even in- 
cluding a score or more of eye, ear, nose, mouth, and throat defectives, 
we have at least a dozen children in every 100 at the threshold of our 
public schools who demand special recognition (classification) and 
special attention from tlie standpoint of educational child hygiene. 
Here at the threshold is the place for timely treatment. For some of 
these children there is no better disposition than prompt assign- 
ment to a special class, the special class method having been put 
into successful operation for 13 different types of children. 

The necessity of improved classification extends to the special 
classes themselves. Take the classes for the feeble-minded. The 
desirability of segregating the lower grade cases from the highest is 
becoming more and more apparent ; this segregation will become quite 
practicable with the development of subnoniial centers. A center 
is a domestic group of classified special classes. The discovery of 



66 SCHOOL HYGIENE. 

the vocational aptitudes of morons is a further part of the task of 
pedagogical classification. 

But of all the special classes the ungraded class (for so-called back- 
\Tard childi-en) stands most in need of inventory. Here are stranded 
all the driftwood and flotsam which can not float upon the ordinary 
channels of the elementary school. The consequent diversity of the 
ungraded class membership is often pathetically picturesque. Here 
is the roll call for one such class in a large eastern city : Twenty-four 
boys, 16 girls ; nationalities, Norwegian, French, Irish, Armenian, 
Italian, Austrian, American, Chinese; names range from James Mori- 
arity and Ong Yung to Arcangelo Christiano and Nishan Kaleha- 
doarian; ages range from 6 to 18; mentality, from giggling imbe- 
cility to ambitious intelligence; morality, from truancy, cigarette 
smoking, and thieving to good behavior; parentage, noted in special 
cases, includes a drunken mother, an overindulgent mother, an illegiti- 
mate father, an insane father, and, in three instances, gypsies ; 
physical condition, from partial blindness and deafness, and spinal 
trouble and anemia, to vigorous physical health. Think of the 
problem before this teacher, who may not even have a working 
definition of feeble-mindedness in her consciousness to aid her in 
classification and instruction. 

The refinement of child classification and the progress of child hy- 
giene go hand in hand. The time is, of course, coming when all our 
large municipal school systems, and perhaps county educational 
systems as well, will have the equivalent of a department of child 
classification and special classes. In a few cities we already hfive a 
working suggestion of the possibilities. Our present classification of 
children is admittedly imperfect. To improve it we need among 
other things psycho-medical experts officially part of the school 
system, resident or semiresident school hygienists, supplementary 
teacher-nurses, trained teacher-diagnosticians, supplementary and 
classification classes. 

Ail the world is a clinic. Some day as adults these individuals will 
be classified by the rigorous tests of actual life. It is the business 
of the j)ublic school to anticipate and perfect the present-day classifi- 
cation of adults, especially that part of the classification administered 
by courts and charity organizations. Child classification is the basis 
of child hygiene. But it is more. The primary school may develop 
into a sociological clearing agency for the discovery and registration 
of all children who, when adults, may prove socially dependent, de- 
fective, or dangerous. Child classification thus becomes a part of 
the task of social hygiene as well. 



MENTAL HYGIENE. 67 

B. THE DISTINCTIVE CONTRIBUTION OF THE PSYCHOEDUCATIONAL 
CLINIC TO THE SCHOOL HYGIENE MOVEMENT. 

J. E. W. Wallin. 

Uniceraitij of Pilishiirfjh. 

America has recently developed a new type of school inspection 
parallel and coordinate Avith, but entirely different from, dento- 
medical inspection, namely, the psychoedncational inspection of men- 
tally unusual children. The first so-called psychological clinic was 
established in the University of Pennsylvania about IT years ago, 
but we now have in the United States from 35 to 40 psychological 
clinics, more or less expertly manned, in the universities, schools, 
and institutions, besides a large number of dilettantes who test chil- 
dren, but who are neither psychologists nor scientists. 

The psychoedncational clinic performs a service for the school 
child which no other type of clinic is able to perform. Its field is 
the psychoedncational diagnosis and corrective pedagogical treat- 
ment of mentally deviating children. It strives to determine the 
nature of the pupil's inherent mental strength and the character and 
causes of his mental and pedagogical variations in order that it may 
give intelligent advice in regard to the mental hygiene of the child 
and his proper educational classification and training. 

The work of the psychoedncational inspector is not competitive 
with or duplicative of the work of the medical or dental inspector, 
but it is entireh' correlative and supplementary. Xo one is fitted 
for the work of psychoedncational diagnosis and treatment who is 
not thoroughly grounded in experimental, educational, and clinical 
psycholog}^, child study, elementary methods, corrective pedagogics, 
the methods of case-taking, and the rudiments of neurology and 
psychopathology. 

At the free psychoedncational clinic conducted by the University 
of Pittsburgh, 11 per cent of a certain number of consecutive cases 
examined were classified as supernormal, 9.9 per cent as retarded, 
39.2 per cent as backward, 11.6 per cent as border cases, 17 per cent 
as feeble-minded, 8.8 per cent as morons. 6.6 per cent as imbeciles, 
and 0.5 per cent as idiots. The different types included mongols, 
cretins, paralytics, choreics, epileptics, child prodigies, speech de- 
fectives, psychasthenics. Freudian cases, and cases of infectious 
infantilism, and ataxia without mental impairment. I\Iany of these 
cases came fallaciously diagnosed. In many cases the parents had been 
utterly misled as to treatment and prognosis and very many had been 
educationally neglected in the schools: that is, they had for years 
l^een forced to do Avork which was not suited to their peculiar needs. 

The moral is clear: Society must proA'ide the machinery whereby 
the numerous mentally deviating children in the schools may be 



68 SCHOOL HYGIENE. 

accurately, mentally, and educationally diagnosed and classified. 
Only thus can we economically and scientifically train " all the chil- 
dren of all the people." 



C. MENTAL HYGIENE IN THE SCHOOL. 

William H. Burnham. 
Professor of Pedagogy, Clark University. 

From the point of view of hygiene it is better to prevent mental 
disorder by observing the principles of hygiene in the school than to 
cure mental disease by reeducation in the sanitarium. If education 
is necessary for the mental health, it is better to give it before rather 
than after nervous breakdown. As for pedagogy, there is no conflict 
between a sound doctrine of pedagogical efficiency and the scientific 
teachings of mental hygiene. 

The outcome of the vast number of investigations of the optimum 
conditions of work and the causes of fatigue during the last 25 
years has been to make emphatic the following points: That work, 
as well as rest, is necessary for the health of the human organism; 
that both function and relaxation are necessary; that the explosion 
of energy, as well as the storing of energy, is a condition of health ; 
that by working hard with close concentration some degree of immu- 
nity to fatigue may be attained ; and, on the other hand, that rest is 
equally important with the time spent in studj^ Recent psychological 
experiments have shown the great improvement in efficiency effected 
by regard for these principles. Let me recount these somewhat in 
detail : 

Some years ago I had the opportunity to make a brief study of 
retroactive amnesia, of that class of cases where a shock or the like 
obliterates the memory for a brief period preceding the accident. 
Such cases are familiar to everyone, perhaps. From such cases I 
found evidence that led to the tentative conclusion that the amnesia 
was due to the fact that the memory was never completely organized. 
That new impressions may become a part of the permanent store of 
memory it is necessary that a certain period of time should elapse 
in order that a process of organization or consolidation may take 
place. In normal memory these processes of organization are con- 
tinually going on, and in order that ideas may be permanently 
remembered, sufficient time vcmsi elapse for the organization to be 
completed. A shock or the like that arrests these processes of 
organization obliterates the memory. 

Bergstrom and others have since found experimental evidence of 
this process of consolidation. Muller and Pilzecker found that in 
learning nonsense syllables less was retained if immediately after 
learning a series the observer was required to concentrate attention 



MENTAL HYGIENE. 69 

on some other task — a careful observation of a picture or the like — 
and they assumed that the mental strain of the latter checked the 
consolidation process necessary for a permanent memory. This 
result strongly suggests also that interference of association occurred, 
due to the task requiring attention. 

That interference of association is especially likely to occur in the 
first few minutes after anj^thing has been learned seems to be most 
strikin^gly illustrated by these experiments of Muller and Pilzecker. 
After learning a series of nonsense syllables by the method of paired 
associates, they gave the observer a task requiring concentration of 
attention a few seconds after the learning of the original series was 
completed. Again in another series the task requiring attention was 
given six minutes after the original series was learned. In the first 
series there was not time for organization before the distraction was 
given ; hence less was remembered, probably on account of the greater 
interference of association. 

The practical bearing of this is obvious on a moment's reflection. 
Haste in learning defeats its own end, and a short rest may fre- 
quently be distinctly more advantageous than continued work. For 
the organization of permanent memory, and to avoid confusion, it 
is especially necessary that suitable periods of rest should occur be- 
tween the learning of disparate topics. In the schoolroom, for ex- 
ample, from purely pedagogical reasons, not to mention hygiene, 
it is usually wise to give a rest of 5 or 10 minutes, at least after 
one recitation or the study of one subject, before taking up a dif- 
ferent one. Especially after the learning of a fact or principle of 
prime importance, a rest of a few minutes to give time for the 
organization of the memory may be a distinct advantage. The hurry 
from one topic to another in the ordinary class drill does not usually 
mean efficiency. The teacher crowds as many points as possible into 
the recitation, has little time for drill and application, and one minute 
before the close of the hour assigns the lesson for the next day with- 
out explanation or illustration. 

From the point of view of hj^giene such methods mean interference 
of association, confusion, and worry. It is not a matter of indif- 
ference to health whether five or six hours a day for a long period 
of school life be spent in hurr}^, attitudes of nervousness, and con- 
fusion, or in developing habits of concentrated attention and orderly 
association. It is precisely such conditions in the schoolroom and 
often in the home that have developed the nervous irritability and 
instability proverbial among Americans. It is the disgrace of the 
school that its graduates have to be reeducated in the hospital and 
the sanitarium. 

A wise and successful superintendent told me some years ago that 
he sometimes thought his best teachers were doing the least for their 



70 SCHOOL HYGIENE. 

children, because they were doing too much for them, and gave them 
little opportunity for self-assertion and self-activity. This is typical 
of many schools, and so it has come to pass from the point of view 
of hygiene and these recent experimental studies that often those 
who teach least instruct the most, and the poorest teachers do the 
most for the children. The oft quoted and frequently resented words 
of Kraepelin, that the inattention of children is their salvation, and 
uninteresting teachers a hj^gienic necessity, have assumed a new sig- 
nificance. Kraepelin might have added that uninteresting teachers 
are often a pedagogical necessity, because they alone give children 
the periods of idleness necessary for the organization of permanent 
memories and of what may happen to be learned. 

The business of the school is supposed to be learning, but learning 
means the acquisition of new material, its assimilation, its organiza- 
tion as a part of permanent memory. The essential conditions of 
this process, however, are concentration of attention, orderly asso- 
ciation, freedom from hurry and nervousness, mental poise, and an 
attitude of leisure. 



X. ATHLETICS AND HEALTH. 



A. EFFECTS OF ATHLETICS UPON HEALTH. 

C. F. Stokes, M. D., 
Surgeon-General, United States Xavy. 

In 1911 the medical records of 625 star or specialized athletes of 
the classes of 1892 to 1911, inclusive, at the Naval Academy were 
carefully examined and the results of this investigation published. 
In 1912 the records of 580 nonathletes of the same classes were 
examined, not so much in the expectation that the physiological 
question involved Avas susceptible of being answered definitely by 
mathematics alone, as in response to the general request for further 
information. 

The results obtained sIioav that 22 casualties (retirements and 
deaths) occurred among the nonathletes as compared with 21 among 
the athletes. Further, it Avas found that from those diseases selected, 
to which athletics have a possible or probable causative relation, 
there has been but 1 death among nonathletes as compared with 6 
for the athletic group. The number still in the service whose medical 
3'ecords shoAv the listed abnormal physical conditions is 187 for non- 
athletes, as against 198 for athletes. The following conditions or 
disabilities show an excess amounting to 50 per cent or more among 
athletes: Arteriosclerosis, valvular disease of the heart, cardiac 
irregularitv, cardiac dilatation, cardiac hypertrophy, gastric disturb- 



ATHLETICS AND HEALTH. 71 

ances, albuminuria, general poor health, obesity, tuberculosis, and 
various traumatic lesions as well. 

This bare statement of fact shows that in casualties and in the 
listed abnormal pliysical conditions the nonathletes and the athletes 
are about equal, but this is misleading without due consideration of 
other factors involved. It must be remembered that the athletic 
gi'oup consists of a body of " twice-picked " men, yet, despite the 
handicap of supposedly better physical material, the casualty list of 
the athletes about equals that of the nonathletes. Another element 
in this consideration which must carry great w^eight is the fact that 
those who attempted to enter the athletic list and failed are counted 
among the nonathletes. Further, the records naturally fail to show 
those whose physical disabilities are of such a character as not to 
cause their admission to the sick list, yet whose efficiency has been 
impaired by them. There are many such officers in the service who 
consult medical officers for cardiac irregularities, obesity, or physical 
staleness, in other words, for conditions that may be attributed to 
excessive physical development followed by periods of physical 
quietude exacted by service conditions. These causes do not become 
matters of record unless thej are of such moment as to render the 
officers wholly unfit for duty, yet such influences in many instances 
materially affect the military efficiency of the individual and should 
be averted, if possible. 

It is interesting to note that among the 625 athletes there were 
15 individuals who developed hernia and this disability appears to be 
associated particularly with a football record. This game, though 
somewhat hazardous as played, is considered dangerous by reason of 
the disabling after effects that, in my opinion, make it questionable 
as a sport to be encouraged, at least where future naval officers are 
being trained. Long-distance crew or foot racing appears to throw 
the greatest strain on the organism, since the effort is severe as Avell 
as long continued. 

It seems reasonable to suppose that the disabilities among the 
athletic list are largely due to spectacular athleticism among young 
men who are prone to overtrain or hazard too much and would not 
have been acquired had the overstraining and overtraining not been 
indulged in. The prolonged, rigorous course of physical exercises 
necessary in ph^^sical sports is believed to be dangerous in its after 
effects upon those who indulge in athletic sports sufficiently to excel 
therein and I wish to emphasize the fact that we ought to look for 
the after effects of athletics among those who tried to excel and 
failed; it is here, I am convinced, that we shall find a high degree 
of damage. 

Aside from the injuries produced the test of modern college ath- 
letics lies in the question as to whether or not they help the business 



T2 



SCHOOL HYGIENE. 



Or professional man in his after life. Personally, I am convinced 
tliat this function is not fulfilled. I feel sure that those who are in 
a position to judge will agree with me. Not only does the modern 
method of physical training- turn out men who easily fall prey to 
degenerative changes, but it wholly neglects the bulk of the young 
men in college life, they (the "nonathletes") being left to gain what 
physical development their own initiative inspires, unguided and un- 
recorded. The tendency is to select those already well developed, 
train them and grind them until the '" unfit'' are weeded out, and then 
overtrain the remainder. 

I am not arguing for less athletics. In fact, I believe we should 
have more athletics, but they should be of a character to produce a 
well-rounded development of all rather thanan excessive develop- 
ment of a fcAv who are already well equipped physically. Such phys- 
ical training should be compulsor3% marked upon a basis of stand- 
ards, and be as much required for graduation as excellence in Greek. 
Latin, or mathematics. It should produce a supple, agile, all-round, 
well-developed individual, not a muscle-bound mass of brawn. 
Clear minds and developed muscles are conducive to prompt, well- 
directed action in emergency and it is this mental and muscular 
balance and resulting self-reliance for which one should strive. 



B. SCHOOL ATHLETICS FROM A MEDICAL STANDPOINT. 

J. W. KiME. M. D., Fort Dodge. Iowa. 

There are athletic events, especially those of the track, that are 
too strenuous for the boy; they are unreasonable, inhuman, brutal. 
Every track-event race above the 220-yard dash belongs to this class: 
the quarter-mile, which calls for the highest speed, the last ounce 
of effort the boy can command from start to finish; the half-mile: 
the mile race ; the two-mile ; and everything of this class or kind. 
These things are not educational, not developmental ; they are foolish, 
injurious, inhuman. 

In all these races above the 220, many boys reach the line com- 
pletely exhausted ; every cell and fiber of ever}^ tissue in their bodies 
has been called upon to give its last unit of strength; heart and lungs 
have been driven to the extreme limit of their endurance ; the vessels 
are at the point of bursting under the mighty pressure of the heart, 
and frequently these vessels do give way and hemorrhages occur. 
Many fall across the line and are carried from the field struggling 
for breath. 

Would I abolish athletics? No; but I would make athletics sane. 
I would not force the boy as I would not drive a horse or abuse a 
dog. I would make every feature of school athletics fall within the 



ATHLETICS AND HEALTH. 73 

reach of the boy. I would safeguard it at every point by thorough 
medical guidance. 

I would eliminate all that is harmful, and utilize that which will 
develop the physical body of every boy and every girl regardless of 
ability to compete on track or field. 

Physical calture and development for all, rather than the pace 
which kills for the few should be the aim. 



C. ATHLETICS FOR ELEMENTARY SCHOOLBOYS IN BOSTON. 

Edgar L. Raub. 
Suhniasler, John ±, Andreics School, Boston, Mass. 

In Boston the elementar}^ school sports are under bona fide school 
organization, under school regulations and school rules. These are 
untouched b}' outside interests. No trophies are given, neither cups, 
medals, nor buttons. Winners of events in the spring meet, and win- 
ners of division league schedules in baseball and soccer, receive certifi- 
cates testifying to the fact. These, like graduation di^^lomas, bear 
the signatures of the chairman of the school committee and of the 
master of the school attended by the winner. 

Exclusive authority over school athletics, including the appropria- 
tion of money for playground work, has been vested in the Boston 
school committee by State legislative enactment. The department of 
school hygiene has from the beginning managed the sports of the 
boys with hygienic and educational ends in view. 

Boston is conservative in the range of athletic sports followed, and 
while providing for a variety of athletic interests, affording exercises 
for different groups of muscles, avoids the elaborate program of 
events followed in some cities. Besides baseball and soccer, the prin- 
cipal games for team play, there are short dashes, the shorter runs, 
and relay races — classified as track sports ; standing broad and run- 
ning broad jump; running high jump; running hop, step, and jump; 
and shot put — classified as field sports. There are no long runs, no 
hurdle races, and no heavy shot. 

Ko boy is allowed to compete in more than one event, relay races 
not excepted. This provision has a twofold usefulness: It is a pre- 
ventive hygienic measure primarily, and at the same time it allows 
the competition of an increased number of boys. Xo boy is allowed 
to compete in the meet unless certified by the school physician as 
being in fit physical condition. At the meet held in June, 1913, there 
were no accidents and no cases of overexertion among 1,000 entries. 

The chief features of the present state of Boston's plan are : Entire 
separation of school athletics from outside interests ; close connection 
with the regular school work; type of athletic sports chosen; hy- 
gienic restrictions upon these; spirit of the training given; type of 



74 SCHOOL HYGIEXE. 

men giving instruction — teachers, not simply athletic coaches; and, 
more than anything else, elaborate precautions taken to safeguard the 
boy while making ample provisions for his well-balanced physical 
development, the whole plan operating under special legislative 
enactment. 



XI. THE TEACHING OF HYGIENE. 



A. PROBLEMS IN THE TEACHING OF HYGIENE. 

Lillian M. Towne, Boston, Mass. 

Historkal sumtnary. — The teaching of healt4i in the public schools 
has been before the people since 1797. 

About 1830 the parents of children and the teachers in the schools 
were urged to cooperate in instructing the children. In 1837 came 
an investigation which showed that the teachers of Massachusetts 
needed to be trained in hygiene. From 1850 to 1860 textbook in- 
struction and dogmatic teaching that should make for habit were 
both advocated. 

In 18G8 Horace Mann compiled statistics showing the standing of 
physiology in Massachusetts; and, through his efforts, its teaching 
was voluntarily extended. 

In 1885 physiology and hygiene was made a compulsory study by 
the laws of the Commonw^ealth. 

Present-day di-fficidties, — Sanitary conditions in the schools have 
improved. Medical men have aided; yet the subject is more neg- 
lected than it should be. There is textbook teaching, but not enough 
dogmatic and observational instruction in either elementary or high 
schools. The normal schools of the United States devote too little 
attention to this important department of training. For the pros- 
pective teacher, help is needed all along the line. 

Advances in Boston. — In 1908 a committee of teachers planned a 
detailed course in physiology and hygiene. This course in 1910 was 
cut down to minimum essentials. 

The board of superintendents adopted the teachers' plan, doubled 
the. time given to the subject, replaced old textbooks wdth new books, 
added books for reference and supplementary reading, provided for a 
''Hygiene teaching exhibit," made possible the purchase of Lang- 
W'Orthy's dietary charts for each district, and authorized a course in 
"Applied physiology and hygiene " for teachers taking promotional 
examinations. The Boston Ph^^sical Education Society devoted a 
meeting to demonstrations of grade teaching in physiology and 
hygiene that interested educators and medical men. 



TEACHING OF HYGIENE. 75 

Needs of the future. — 1. School authorities and associations must 
see that health teaching has its jn-oper share of time in the school 
curriculum. Organized effort alone can accomplish this. 

2. There is need for scientific combination of courses in hygiene 
and in nature study in the elementary grades. 

3. This should be followed in the high school by a course in 
physiology and hygiene, differentiated to meet the needs of pupils 
entering specific types of vocations. 

4. Normal schools must amplify knowledge in subject matter, and 
must give definite training in teaching method and in hygienic habit 
applicable to the schoolroom. 

5. Teachers in service must be aided to keep in touch with advance 
in hygienic knowledge through distribution of pamphlets and by 
illustrated lectures. ; 

There is immediate need of simple charts and models, of slides and 
apparatus, whereby the teaching of hygienic principles may be made 
concrete and experimental as in other subjects. A list of reading 
references for pupils is also needed. 

G. If the application of hygienic principles is to have importance 
for the child, the carrying out of hygienic habits should be made a 
factor in his advance from grade to grade. 



B. PROTECTION OF STUDENT HEALTH IN THE COLLEGE OF THE CITY 

OF NEW YORK. 

By Thomas A. Storey, M. D., 
Professor of Hygiene, Xeiv York, X. Y. 

The protection of student health in the College of the City of New 
York is accomplished through the organized activities of the depart- 
ment of hygiene and by certain committees appointed by the presi- 
dent of the college. These committees are " The advisory committee 
on hygiene and sanitation " and " The committee on student lunch- 
rooms." The professor of hygiene is chairman of each of these com- 
mittees, both of Avhich are advisory to the president. 

There is no dormitory life in this institution. There are,' there- 
fore, no problems in dormitory hygiene or sanitation. The students 
in the collegiate department and the pupils in the preparatory depart- 
ment live at heme in the various boroughs of Greater New York. 
Their home conditions are, therefore, communit}^ affairs, and fall 
under the jurisdiction of the board of health and other divisions of 
the city government which bear upon community hygiene and 
sanitation. 

The entire organization of the department of hygiene has been 
developed primarily in the interest of student-health intelligence 



76 SCHOOL HYGIENE. 

and student-health habits. For the accomplishment of these results 
the department has employed carefully planned lecture courses on 
h3^giene, class and personal instruction in health habits^ and indi- 
vidual examination and instruction in personal hygiene. 

The courses in hygiene required of the freshman and sophomore 
classes in the collegiate department include a series of short lectures 
rumiing through four terms, graded instruction in physical exercise, 
and regular inspection in personal hygiene throughout the same 
period. The individual instruction in h^^giene is further accom- 
plished b}^ means of regular medical examinations applied to each 
individual student at least once each term throughout the first tliree 
years in the academic or preparatory department and throughout 
the first three years in the collegiate department. In all of this 
instruction emphasis is laid upon the individual. The lectures are 
organized with distinct reference to the health problems that arise 
in the daily lives of students living in a great city. The health 
habits taught are the simple, fundamental habits most essential 
to physiological efficiency, greater stress being laid upon the needs 
of the city boy. The individual instruction in personal h3'giene is 
based upon information secured by means of thorough medical ex- 
aminations of each individual concerned. 

The lectures on hygiene are made up of a series of 16 short talks 
on " The Causes of Disease " ; a second series of 16 short talks on 
" The Carriers of Disease " ; a third series on " Our Defenses against 
Disease " ; and a fourth series on " The Nature of Som.e of Our 
Common Diseases." 

Classroom instruction in health habits is accomplished through 
four terms of work in the freshman and sophomore years in the 
exercising hall of the gynasium. Here are taught habits of physical 
exercise, habits of personal cleanliness, and habits of community 
hygiene. The sanitation of the exercising hall, the locker room, and 
the swimming pool, as well as the objective hygiene of the individual, 
are emphasized as matters of community importance and each student 
is taught his obligation to himself and to the community in which 
he lives in his relation to his felloAV students. In this connection it 
may be noted that the swimming pool serves as a sort of an index to 
the standard of hygiene maintained by the student community using 
the pool. If the bacteriological analyses show evidences of human 
contamination, the fact is brought to the attention of the classes 
using the pool and the responsibility is placed upon them. With 
repeated careful instructions concerning the need of thorough bath- 
ing before entering the swimming pool ; the necessity of washing the 
private parts; and the importance of keeping all respiratory, bowel. 
or bladder excretions out of the water in the tank: the subsequent 



TEACHIXG OF HYGIENE. 77 

bacteriological analyses invariably show an improvement in the 
sanitation of the water. 

The medical examinations which form the bases for instructions 
given the individual students concerning their hygienic needs cover 
the skin, scalp, eyes, ears, nose, mouth, throat, heart, lungs, abdomen, 
and genitalia. Wherever it is indicated, chemical and bacteriologi- 
cal examinations are made. The college has recently equipped a 
departmental laboratory and employed the services of a competent 
man for the purpose of identifying disease carriers among the stu- 
dents and supplying the department with information upon which 
it can furnish advice to the individual student concerned. It is 
planned within the coming year to utilize this laboratory service for 
the possible detection of typhoid can-iers and diphtheria carriers in 
the student body. 

All individual instruction which admits of being followed up is 
followed up. The individual student concerned is required to report 
to the department until his case is closed. Failure to report as 
directed may lose to the student his membership in the institution. 
The success of this instruction and its follow-up feature is demon- 
strated by the fact that less than 1 per cent of the cases followed up 
fail to report as directed. About 96 per cent of them finally secure 
advice and treatment through their regiilar family advisors, while 
less than 4 per cent report to free clinics in the various hospitals of 
the city. 

The characteristic and striking features of the work in this depart- 
ment are. first, its practical application of the laws of hygiene to the 
needs of the individual ; second, its instruction in communitj^ hygiene ; 
third, its successful follow-up system in the interest of individual 
instruction in personal hygiene. 



C. SCHOOL HEALTH WORK IN MISSISSIPPL 

Susie V. Powell. 
Superviso)- of School Iniprovemeut Associations^ Jaclxson, Miss. 

The Mississippi School Improvement Association is promoting 
better health conditions principally by the following means: 

1. Special days. — (a) Clean-up-and-beautify day is observed at 
the close of the school in the spring, and again at the opening of the 
school in the fall. These days are observed by at least 2,000 schools 
and communities with direct benefit. On these days the people 
'•work with their hands" and thus learn by doing. (5) A special 
health-day program is issued and observed b}^ just as many schools. 
0,n this day, in addition to actual work done to improve health con- 



78 SCHOOL HYGIENE. 

ditioiis, a formal program is given to educate the people in matters 
pertaining to health. 

2. Cor I elation. — Plans, instructions, and suggestions for correlat- 
ing the* regular textbook work with the practical health work are 
issued to the teachers so as to reenforce the abstract theories' with 
concrete examples. The pupils prepare booklets in which health- 
improAement material forms the basis of exercises in the regular 
school branches as follows : 

Spelling. — Spell and define words used on the health placard and in the biil^ 
letius issued by the State board of health. 

Arithmetic. — What is the ratio of window space to floor space in your school- 
room? How many cubic feet of air does your schoolroom contain? How 
many pupils? If each pupil breathes 10 times in a minute, how long will this 
air last? What is the surface area of the dipper? If one square inch contains 
1,500 disease germs, how many may the surface of the dipper contain? 

Compute the cost of a sanitary closet. Find the area of the schoolroom 
floor and estimate cost of oiling it at $1 per gallon. Estimate the cost of put- 
ting the school in good sanitary condition : Cleaning, disinfecting, prevention 
of dust, pure water, etc. Compare with average cost of a case of typhoid fever, 
tuberculosis, pneumonia. 

History. — Biblical; London plagues; yellow fever epidemics; vaccination, etc. 

Civics. — Rights and duties. Obligations of the community to the individual: 
To provide clean, comfortable, healthful environment; to provide expert super- 
vision ; to isolate those suffering from communicable diseases ; to give inspection 
and instruction to the young on sanitation and hygiene. Obligations of indi- 
viduals to the community : To refrain from promiscuous spitting ; to observe 
laws of personal cleanliness; to avoid exposing others to communicable dis- 
eases ; to do one's part in keeping house and premises in good order. Laws on 
Mississippi statute books relating to health. 

Physiology. — Sanitation and hygiene ; germ theory; ventilation; lighting; heat- 
ing ; bone structure and necessity for adjustable desk ; the eye and necessity for 
proper lighting; ear, nose, and throat and teeth, with need for inspection and 
care; the skin and necessity for cleanliness; digestion and proper food (the 
children's lunches) ; the lungs, and proper ventilation; the blood and effect of 
air, light, and other hygienic conditions; bone and muscle structure; exercises 
in correct posture and physical culture ; dangers from spitting. 

EagVish. — Classify words on the health placard as nouns, verbs, adjectives, 
adverbs, prepositions, conjunctions. Make sentences illustrating principles in 
grammar, regarding any health topic mentioned above. Write a paragraph 
each on " Danger, sources, and prevention of dust in the schoolroom." Wyite 
composition on : " How we observe clean-up-and-beautify day ; " " health day ; " 
" IIow we clean our schoolroom;" "The need for individual drinking cups;" 
"our water supply;" "The hookworm a greater menace to our State than the 
typhoid fly ;" " Resolved : That we need medical inspection in our public 
schools." 

Geography. — Surface water and ground water; drainage. 

Writing. — Copy sentences from health placard. Copy the themes neatly and 
make into a booklet. Copy the poems about health. 

Hinging. — Motion songs; breathing exercises. 

?). Addresses on sanitation. — The local. and county school improve- 
]iient associations have been put in touch with special agents of the 



TEACHING OF HYGIENE. 79 

State board of health and other helpful agencies. These men are 
invited to attend the local and county meetings and make addresses 
on tuberculosis, typhoid, hookworm, and other preventable diseases. 
Local physicians and county health officers are also invited to visit 
schools and make inspections and give instructions. 

4. General improvement. — Marked improvement is reported in at 
least 1,500 schools in water supply, ventilation, prevention of dust, 
lighting, heating, and building and care of outhouses. It is very 
common to find the floors of rural schools oiled; the furniture and 
walls cleaned with sanitary dust clothes, outhouses built and kept in 
good condition, window sashes and shades arranged for ventilation 
and correct lighting, and the people generally awaking to the im- 
portance of better health conditions in the home and school. 



D. MUSEUM COOPERATION IN THE TEACHING OF HYGIENE AND 

SANITATION. 

C. E. A. Win SLOW, 

American Museum of Natural History, Xeic YorJ:, X. Y, 

In the hall of public health of the American Museum of Natural 
History we have now, after three j^ears' work, installed three fairly 
complete series of exhibits dealing with water supply and public 
health, with the disposal of city wastes and with bacteria, while a 
fourth series, illustrating the relation of insects to disease, is well 
under way. 

The relation of insects to disease is a particularly fruitful field for 
museum work and is the one upon which we are chiefly engaged at 
the present time. The American Museum already has in its depart- 
ment of invertebrate zoology wonderful enlarged models of mosqui- 
toes, and the department of health has just installed a model of the 
house fly* enlarged 40 diameters, which took a skilled artist modeler 
Jiearly a year to complete. A wide series of facts bearing on the life 
history of the fly are illustrated, as Avell as the relation of the fly to 
disease, the practical methods for its control, and the results achieved 
thereby. A similar, but more enlarged model of the flea (carrier of 
bubonic plague) is now under preparation, and we have already in- 
stalled models, some small and some life-size, dealing with the rats 
which harbor the plague microbe and from which the flea carries it 
to man. The opportunity for future development here, and in con- 
nection with the mosquitoes of malaria and yellow fever, and a score 
of other disease carriers, is a tempting one which we hope to develop 
in the next few years. 

13011°— 13 6 



80 SCHOOL HYGIENE. 

This hall is our first opportunity to serve the public schools in the 
work of health education. The teachers bring their classes to the 
museum in one of the periods allotted to civic biolog}\ and in an hoiir 
with these models and diagram the pupils learn more than they could 
get from books and lectures in a month. 

In addition to the hall, which is open to all the visitors to the 
museum (numbering 800,000 a year), w^e arrange special lectures to 
the school children on the occasion of their visits. It is the policy of 
the museum to provide lectures (generally illustrated) on any sub- 
ject within the field for any teacher Avho may ask it and for any num- 
ber of pupils, from a score to a thousand. Or, if the teacher prefers 
to lecture himself, we provide hall, lantern slides, and operator. The 
larger high schools send their classes twice a yelir near the end of each 
term for a talk on water, milk, insect-borne disease, city cleaning, or 
some other topic which fits into their course. 

For some time the American Museum has taken an active part in 
the nature-study work of the public schools by circulating loan collec- 
tion of birds, insects, mollusks, sponges, corals, woods, minerals, and 
the like. At the instance of some of the high-school teachers most 
active in civic biology, we have applied this same plan to our public- 
health extension work. Our first attempt was in the form of an 
album of large photographs dealing with the spread and prevention 
of communicable diseases. 

During the past half year, these albums went to 10 high schools 
and 22 elementary schools in the city, and were used by 52,610 chil- 
dren. The general method pursued by the teacher is to go over them 
pretty thoroughly in the higher grades, and then to bring them into 
the general assembly hall, where a talk is given upon them and 
where they are often left for inspection for a considerable period. 
The time for which one of the albums is kept in a school varies from 
eight wrecks to four months, and one distributing agent reports that 
" once a teacher gets an album, she will not release it until her chil- 
dren have seen it several times, and until the other children in the 
school have seen it." 

All this is, of course, onlj^ a beginning of what we hope to do, even 
for Ihe high schools. We have as yet scarcely touched the great un- 
derlying problem of the elementary schools, where it is most vital 
that a sound basis should be laid for healthy living and where at pres- 
ent (in 'New York City) 15 minutes a week is the maximum time that 
can be spared for theoretical instruction in hygiene. We do feel, 
however, that we have done enough to show that museum methods of 
instruction may be made of use in the teaching of school hygiene and 
sanitation. 



TEACHING OF HYGIENE. 81 

E. AN EXPERIMENT IN STUDENT CONTROL OF SCHOOL SANITATION 

AND HYGIENE. 

G. W. Hunter, 

De Win Clinton High School, Xeic York, N. Y. 

The great elementary and secondary schools of New York City 
form excellent experimental ground for much-needed cooperation be- 
tween pupils, teachers, and civic authorities to obtain safe and sani- 
tary conditions of life during the time that the persons involved are 
in the school buildings. The city may supply the plant, sanitary and 
well equipped; it may safeg^iard the water and food supplies fur- 
nished to pupils; and it may send teachers into the work tempera- 
mentally and scientifically fitted to do the work of instruction for 
sane and sanitary living ; but if the student body does not cooperate 
with the teaching staff and the civic helpers outside the school, then 
the school building and its surroundings will be as hopelessly insani- 
tary as if the message of the individual drinking cup and the indi- 
vidual towel had never been preached. 

An attempt to obtain cooperation has been made in the De Witt 
Clinton High School. This school, one of the largest boys' schools in 
the United States, is ideal for such an experiment because of its 
l^eculiar environment and its cosmopolitan clientele. The building, 
a splendid example of modern school architecture, is located on the 
border of one of the most unsavory localities of the city, an area 
where the gang element in its worst form runs riot, and where race 
battles are not uncommon even in broad dajdight. The streets near by 
are offensive and ill-kept, the one redeeming feature being the close 
proximity of the school to two large hospitals. The school building- 
is used day and night throughout practically all the year, housing a 
great day school, a night school, and a lecture and recreation center. 
Probably 5,000 persons daily enter its doors. Of the student body, 
over 75 per cent are foreign born, in most cases the migration having 
been very recent. Most of the boys, especially the " eastsiders," are 
well behaved and anxious to learn, but have never had an opportunity 
in their home surroundings to know what real sanitary and hygienic 
conditions are. Consequently, in spite of watchful teachers and 
efficient janitoral staff, the halls, rooms, and in particular the stair- 
ways and lunch room, often presented an appearance that was far 
from sanitary. 

Each half year in Septemb-er and again in February, nearly 800 
new pupils, fresh from the many schools of the various parts of the 
city, each with their own standards, enter the portals of the school. 
It was from these entering classes, aliens, without any idea of what 
the school and its activities stood for, that we exDerienced the most 



82 SCHOOL HYGIENE. . 

difficulty. Xo conventions bound them, school traditions were as yet 
unknown, and the preaching of their teachers and the practical work 
of their biological and hygiene training had not j^et begun to bearr 
fruit. A trail of torn papers, chalk dust, and cast-off luncheon came 
to follow certain of these first-term classes. 

Then came the thought : If these boj^s are unwittingly the offenders 
against the decenc}^ and self-respect of the school, why not make them 
sow the first fruits of a propaganda against this lack of consideration 
of others ? Calling together half a dozen of the better element from 
among the incomers, a plan was evolved, the details of which follow. 

Boys in the school for convenience in distribution are grouped in 
sections of about 35 pupils, each section being assigned to a given 
home room in charge of a single teacher who acts as their advisor, 
and to whom they recite in one subject. In this home room the sec- 
tion has most of its study periods ; there they discuss the affairs which 
are solely section matters; and activities of various sorts are organized 
there. WhatcA^er esprit de corps the section possesses arises in their 
home room from the fellowship aroused by meeting together in the 
morning or after school. Plere was evidently the place to strike first; 
so notice was sent out of a meeting to which each first and second 
term section was asked to send delegates. These delegates became 
the nucleus of what was later known as the Sanitary Squad of the 
De "Witt Clinton High School. 

At this juncture we evoked the aid of Mr. Reuben Simons, of the 
department of street cleaning. This gentleman had clone work of 
a similar nature among much jJ^ounger bo3"s in the elementary schools, 
and knowing bo}'' nature, came forward with the offer of badges, 
to be used by the squad members as a distinctive mark of authority. 
Committees were then formed, officers elected, and the work of the 
organization began. An executive committee, an improvement com- 
mittee, the duty of which was to suggest improvements in and about 
the building, a street committee to police the streets during the lunch 
periods, a hall committee, whose members policed the halls at all 
hours of the day and brought offenders against law and order to 
justice, a lunch-room committee, Avhose onerous task was to "clean 
up "' the lunch room, and finally a social committee, whose business 
it was to provide the programs for the meetings held every Tues- 
day afternoon. The officers of the club were a president, vice presi- 
dent, secretary (for there were no dues), and a faculty director. 
These officers made up an executive council, and in reality directed 
the interests of the squad in the right directions. 

One of the first useful activities of the squad was to draw up and 
have printed a set of suggested rules of conduct. These printed 
notices were posted in every room in the school building and on all 
bulletin boards in the halls and lunch room. Then, with the aid of 



TEACHING OF HYGIENE. 83 

large stencils, signs were printed, ^Yllich were placed in the hmcli room 
and in the halls. These signs reminded the students that the cost 
of the lunch furnished depended in the long run upon cooperation 
between school authorities and the student body. 

The work of the squad was at first directed toward bettering the 
conditions in the lunch room, where over 2.500 boys were fed almost 
every school day. Then, widening their circle of influence, they 
took charge of the halls and rooms all over the building, and finally 
the condition of the streets adjacent to the school was taken in hand. 

During the recent spring " clean-up " campaign waged by the 
civic authorities, the boys personally took charge of the distribution 
of circulars in localities that the}' could cover. Several large meet- 
ings were held to advertise the reasons for this campaign. The last 
meeting was held in the auditorium of the school and attended by 
over 1,500 boys. This last meeting Avas addressed by Dr. MacMil- 
lan, the director in charge of the clean-up campaign for the city. 

But the work of the squad was by no means all plain sailing. 
Xot all boys who joined the squad proved to be trustworthy, for it 
was a hard matter for a 13-year-old boy to see the ethics of picking 
up another fellow's leavings. Sometimes open rebellion on the part 
of the boys who were required to do clean-up work b}^ squad mem- 
bers made matters rather difficult for the director to untangle. Boys 
of the upper classes, who were at times careless, like all other young 
men, resented being asked by a freshman to clean up anything, even 
if they did cause the trouble. So a " strong-arm squad " came as a 
natural evolution from, work in the lunch room where conditions were 
unusually trying. 

On this squad only large boys with a fair amount of tact were 
allowed to serve, and it was considered to be an especial honor to 
attain this position. The usual method of procedure on the ^jart of 
a squad member who saw a schoolmate throw something on the 
floor was to ask him to pick it up. If he refused, he would show him 
his squad badge and again make the request. If this did not bring 
the required response, the squad member Avould take the name of 
the boy and report him to meet the director at the court held every 
i^fternoon. Sometimes the getting of the offender's name would be 
a difficult task and might mean trailing the boy to a recitation room, 
where a teacher would require the name to be given. Every after- 
noon in the office of the director court is held. The director occupies 
the chair, the assistant director acting as the prosecuting attorney. 
The case is first stated against the reported offender, then he is allowed 
to make his defense, witnesses are called for the prosecution to 
rebut any false statements that the prisoner may have made, and 
finally the director pronounces sentence. This may merely consist 
in a reprimand with an invitation to attend the next meeting of the 



84 SCHOOL HYGIENE. 

squad to see what thev are doing'; it Avill be clean-up work under 
supervision of a squad member if the culprit is guilty, and it may 
be in extreme cases a visit from the parents or a week or two in the 
tardy room, an after-school penal colony which houses the careless 
or vicious members of the school community. 

^Vliat is the result of the year's experiment? Can we say that we 
had a changed school at the end of the year? Yes and no. At the 
beginning the attitude of the student body was that of a critical, non- 
sympathetic, and often directly antagonistic body of scoffers. But 
little by little, as they saw the boys of the squad devotedly working 
for the common good, unmindful of the gibes of the crowd, a change 
began to be felt. Older boys, who at first were openly troublesome 
or who made fun of the squad workers, began to take an active 
interest and even to appear at meetings. One body of older boys, of 
their own volition, formed a hygiene club, procured lecturers, and 
began to cooperate actively with the younger fellows. Best of all, 
as faculty recognition came and notices of a favorable nature began 
to make their appearance in the school paper, the student body com- 
menced to wake up to the fact that it was pleasanter to have their 
siu-rounding-s clean. The lunch room, which in former days, after 
the lunch period, was a disorderly chaos of torn papers, half -eaten 
fruit, and spattered odds and ends of schoolboy lunches, became 
really livable, so that after 1,500 boys have finished eating, another 
relay of like size may be sent to the room almost without touching 
the room or its contents. The halls and most of the rooms are now 
kept in fairly good condition, in spite of the occasional dirty or 
careless bo}'. But, best of all, is a spirit, a subtle something, that 
has crept into the school as a whole, which makes the De Witt Clinton 
student think of the other fellov^^ and his rights, helps him to under- 
stand that sacrifice for the right is to be desired, and teaches him 
the best lesson of the future citizen, that of cooperation with author- 
itv for the common S'ood. 



F. IMPROVING HYGIENIC CONDITIONS AMONG THE NATIVE SCHOOL 

CHILDREN OF ALASKA. 

William Hamilton, 
United States Duyeau of Education, 

The efforts of the Bureau of Education to safeguard the health of 
the Alaskan natives include: (1) The maintenance of four small 
hospitals in important centers of native population: (2) contracts 
with three hospitals for the treatment of diseased natives: (3) the 
employment of traveling physicians who devote their entire time to 
the medical and sanitary work among the natives in their districts; 



TEACHING OF HYGIENE. 85 

(4) the employment of nurses vrlio assist the physicians and do ex- 
ceedingly valuable work for the children in the schoolrooms; and 

(5) the providing of medical supplies and textbooks to the teachers 
of the schools throughout Alaska to enable them to treat minor 
ailments and intelligently to supervise hygienic measures. 

In the native villages the teachers and nurses endeavor to establish 
proper sanitary conditions by inspecting the houses, by insisting upon 
the proper disposal of garbage, and by giving instruction in sanitary 
methods of living. Natives are encouraged to replace their filthy 
huts by neat, well-ventilated houses. Many of the school buildings 
contain bathtubs and facilities for the proper washing of clothing. 
In many schools sputum cups and individual drinking cups and 
towels are provided. The bathing and laundry facilities furnished 
are usually greatly appreciated. 

In some of the native villages the results of the efforts of the 
teachers and missionaries are evident in the orderly streets and well- 
built houses containing ail the necessary articles of furniture, pic- 
tures, and books. The natives in places such as these are self- 
respecting, thrifty people, and their children are as clean as those in 
the average village in the States. 

In other settlements not reached by civilizing influences the con- 
ditions are such as to appall the most enthusiastic social worker. 
The houses are wretched hovels, constructed of driftwood, crowded 
together on an ill-smelling beach covered v>^ith garbage of all kinds, 
including discarded articles of clothing, old tin cans, and putrefying 
offal polluting the air with its horrible odors. In such a village the 
houses contain but a single room each, very dirty and without ven- 
tilation. Into it m.en, vromen, and children are herded, a stove and 
a bed being the only articles of furniture. The bed is usually used 
as a "catch-alP' for a great assortment of articles, the natives pre- 
ferring to sit, eat, and sleep on the floor. 

The establishment of a United States public school in such a 
village and the advent of a teacher mark the inauguration of a 
crusade against filth and disease. The methods used in order to 
establish hj^gienic conditions among the school children coming from 
homes such as those just described can best be told in the v>^ords of 
one of the workers : 

Tlie clinic work of the school usually commenced with a talk on parasites 
and the necessity for cleanliness, and this was followed by an inspection of the 
entire class. Two and sometimes three of the older pupils were selected as 
assistants. The boys were taken to the clinic room, and after I had clipped 
eachfiDy's hair my assistants gave him a shampoo with antiseptic soap, dressed 
his hair with a fine comb, and anointed it with coal oil. Talks upon hygiene 
were given each .day and the worst cases were used as illustrations. After 
the talk my assistants examined the heads of all the children, and when neces- 



86 SCHOOL HYGIEXE. 

sary gave the above-described treatuient. The assistants soon learned to do 
their work quickly and well and seemed much interested in it. 

My principal rules were : " Keep clean. Wash your face. Wash your hands. 
Wash your neck. Wash your ears. Wash your teeth every day. Bathe your 
whole body with soap and warm water at least once a week." After these 
rules were well understood, any child who came to school with a dirty face 
was brought before the class for consideration. The usual verdict was " Scrub 
'em good with soap and warm water." After the assistants were through with 
him the subject was usually a shining example of cleanliness. It was most 
encouraging to see the results of a little teaching, for after four or five weeks 
it was a rare occurrence to have a child come to school with dirty hands or 
face. The children soon developed pride in their personal appearance and 
would strive to have their few torn clothes at least clean. The desire for 
cleanliness spread to the homes, and fathers and brothers were frequently 
brought to school to be put through the clipping and cleaning process. 



G. HYGIENE IN THE PHILIPPINE SCHOOLS. 

A. J. McLalghlix, M. D., 
United States Pu'olic Health Service. 

Practical hygiene is taught in the Philippine schools even in the 
lower grades. In this country we are prone to overlook the enormous 
influence of school children upon the hygiene of the home. The 
children of poor, ill-educated parents are often the intermediary 
through which the simple gospel of hygiene and disease prevention 
reaches the parents. In the Philippines this is even more true, and 
m many instances it is only because of the children that the parents 
carry out the instructions of the health officer. 

In combating cholera we were not slow to take advantage of the 
schools. A cholera circular containing the simple facts of the spread 
and prevention of cholera was used as a catechism even in the ele- 
mentary grades. The children recited the answers daily, and in 
times of actual epidemic this teaching took precedence over all other 
studies and was supplemented by actual demonstration of hand 
cleansing and disinfection. 

With an epidemic of contagious disease existing, there is a ten- 
dency in most communities to close the schools. In the Philippines, 
on the contrary, it is the policy of the bureau of health to keep the 
schools open l^ecause of their extraordinary value in teaching the 
precepts of disease prevention. 

They were used in cholera epidemics as demonstrating stations 
where the children were taught how to protect themselves and their 
parents against cholera. The same principle is used in combating 
tuberculosis, hookworm, dysentary, and beri-beri. The children are 
taught how these diesases are contracted and how they may be 
preA'ented. 



MISCELLANEOUS TOPICS. 87 

The modern Philippine school building is a model of construction, 
adapted to the Tropics. There is no heating problem in the Philip- 
pines, and as a consequence ventilation is very much simplified. 
Water suppl}^ and sewage disposal are directly under the control of 
the bureau of health. The pupils are specially trained in the neces- 
sity of thorough hand cleansing after using the toilet and before 
eating. The children have been used also to eliminate the time- 
honored Filipino custom of eating with the fingers out of one common 
family dish. 

The dense ignorance of sanitary principles and the oriental fatalism 
of the older generation could not be successfully combated without 
the aid of the school children. With their aid a very great improve- 
ment has been effected. 

There is now in Manila a very efficient medical inspection of 
schools. This is particularly effective because of the splendid facili- 
ties of the bureau of health for giving medical treatment. The city 
is divided into health districts with free dispensaries and hospitals 
where the school children are treated. In this country the health 
department can often do no more than recommend treatment. In 
Manila the child is reported to the bureau of health, and the powers 
and organization are such that control is easily maintained until the 
child is returned to school cured. Special attention is paid to the 
teeth of children, and these are treated in the free dental clinics of the 
Philippines General Hospital. During the school year ended March 
29, 1912, in Manila over 2,400 children were referred to the hospitals 
and dispensaries of the bureau of health for treatment. 

The effect of the teaching and practice of hygiene in the Philip- 
pine schools is manifest in the improved physical condition of the 
pupils, and it is a powerful instrimient in the sanitary regeneration 
of a nation. 



XII. MISCELLANEOUS TOPICS. 



X. HOW WOMEN'S CLUBS CAN AID THE HYGIENE MOVEMENT. 

Elsa Denisox, 
Bureau of Municipal Research, Xeic YorJc, X. Y. 

The greatest service of women's clubs during the next few j^ears 
will be to apply everywhere what we already know: to use all the 
machinery already available in every city and every country; and 
to carry out definite programs based on the proved experience of 
other communities. 



88 SCHOOL HYGIENE. 

Tlie cities and towns wliere there in not adequate medical inspec- 
tion, examination, and treatment of physical defects, where all school 
buildings are not properly cleaned, ventilated, heated, lighted, out- 
number 10 to 1 the cities and towns where even a beginning has been 
made. 

There is no need for more organizations of women. There is no 
need for wasting precious time while communities " grow up " to 
health facts. There is no need for added experimentation about the 
more important phases of school hygiene, i. e., the physical condition 
of tiie children themselves and the environment they go to school in. 

i\Iay I suggest, therefore, that our *' prophecies and promises " 
for the next few years group themselves under the following four 
heads : 

1. Use facf-giving machinery. — ^>Yomen's clubs will use the machin- 
ery already in full swing to avoid being handicapped by lack of 
facts. Reference agencies like this congress, the United States Bu- 
reau of Education, bureaus of municipal research, the Russell Sage 
Foundation, State and local boards of health, tuberculosis associa- 
tions, etc., are spending thousands of dollars every year getting 
facts, making them available, answering questions. 

2. Dro.w 100 per cent inctures. — Women's clubs will use the machin- 
ery of all organized women, whether in their clubs or in other clubs, 
to give to their city a 100 per cent picture of school health needs in 
that city. If an inspecting committee finds one school with unwashed 
windows and dirty floors, the club machinery will ask, How man}^ 
more? If 90 out of every 100 children in our schools were found 
with decaying teeth, club women will ask, How many more? and 
How can they all be fixed ? If a building is found with one open-air 
room for 20 children and bad air for 980 children in all other rooms, 
club women will ask. What's the use? 

3. Enlist professional cooperation, — Women's clubs will use the 
machinery of their local medical and dental associations and their 
local groups of business men to secure (a) publicity about health 
needs not met; (6) preliminar}^ volunteer examinations; (e) finan- 
cial support by the city. 

4. Solve other health prohlems. — Women's clubs will use the ma- 
chinery of the whole city administration to correct conditions affect- 
ing the health of school children or school buildings. Constant 
"Watching, reporting to authorities specific bad conditions, following 
iij) promised improvements, will be given to the questions of clean 
streets around school and for play: prompt garbage removal: where 
drinking water comes from : how milk is analvzed : what cake, candv, 
soda, and ice cream in shops near schools is made of, etc. 



MISCELLANEOUS TOPICS. 89 

B. THE SCHOOL AND VITAL STATISTICS. 

Fbanklin C. Gram, M. D., 
Chief of the Bureau of Vital Statistics^ Department of Health, Buffalo, N. Y. 

At first thought it might seem that the school and vital statistics 
are antitheses and their points of contact about as opposite as the two 
poles. The same might have been said about medical school inspec- 
tion only a few years ago. In an age of progress the dead languages 
give way to technical education and the philosophy of unknown 
quantities to manual training. Granting this, you will ask. Where 
will the study of vital statistics fit into the school curriculum? 

It needed no argument to make room for the art of bookkeeping. 
Even the unintelligent recognized the necessity of a knowledge by 
wdiich, in his crude way, he might measure his financial loss or gain 
during a given period. Vital statistics is the bookkeeping of a com- 
munity. It shows the assets as well as the liabilities. It does more. 
It forms a permanent record of every individual from the beginning 
to the end of life. 

If we teach our children that certain diseases, such as measles and 
whooping cough, which have been regarded as blessed essentials of 
childhood, and which our mothers were w^ont to invite by contact in 
order to have them over with as early in life as possible, are not 
essential but more fatal than dreaded pestilence, then we assist them 
in retaining a normal constitution and possibly prevent them from 
filling an early grave. 

The reduction of infant mortality has long ceased to be a subject 
of philanthropy or of public spirited benevolence. It is a recog- 
nized duty of the State. The State can do nothing without the co- 
operation of its citizens, and unless its citizens can be made to under- 
stand a condition there can be no cooperation, because it then becomes 
a matter of law and not of duty. 

To a proper study of these things it is essential to have some 
knowledge of morbidity and mortality conditions. It is necessary to 
knovr the number of births in a community in order to compare it 
with the number of deaths. Vital statistics show at what period of 
life the lowest and highest mortality rates exist, the causes Avhich 
produce death at later periods, and this again leads to the study of 
prevention. Connected with this study is a natural inquiry into the 
causation of disease, and while such study still presents many obsta- 
cles to the untutored mind, yet it is within the range of possibility. 

Nor is such study without profit to pupils before they reach high 
school or college. It is particularly valuable before that stage is 
reached, because during this period of life many of the contagious 
diseases occur which cut short a promising career or lea^ e the indi- 
vidual burdened with an infirmity for life. 



90 SCHOOL HYGIENE. 

The study of vital statistics is entitled to a place in schools on the 
following grounds: (1) It leads to an inqniiy into morbidity and 
mortality conditions of the home locality; (2) it forms a basis for 
comparison with what such conditions ought to be; (3) it assists in 
the study of prevention of disease and in the knowledge of public 
health; (4) it is an essential adjunct to medical school inspection 
and school nursing; (5) a knowledge of health and disease forms the 
buhrark of nations; (6) youth is the best period in life for beginning 
to acquire such knowledge. 



C. ACCIDENT PREVENTION AS RELATING TO CHILD WELFARE. 

Marcus A. Dow, 

General Safety Agent, Xew York Central Lines. 

Remarkable results have been obtained in the actual reduction of 
industrial accidents through the education of industrial workers 
along the lines of safet3% in many instances large plants or railroads 
showing decreases ranging from 10 to 40 per cent in casualties in one 
year. In a very brief period the plan of systematic education of in- 
dustrial workers in accident prevention has proved effective and suc- 
cessful. Why should it not be just as successful if applied in schools ? 
The great need for a concerted, well-defined plan of teaching school 
children " safety," " prudence,'' and " carefulness " is apparent when 
the great number of lives sacrificed annually is considered. 

The railroads do not begin to furnish all the accidents that result 
in serious or fatal injury to children and others. The dangers that 
beset the child in dail}^ life are numerous and varied. Matches and 
bonfires, the automobile, the street cars, vehicles drawn by horses, and 
manv other things contribute to the huge list of deaths and injuries 
to children from accident causes. 

In Xew York City alone there were 226 children killed and 479 
seriously injured while playing in the city streets during the year 
1912. In the States of New York and Xew Jersey during the same 
year there Avere 1G4 children under 16 years of age killed by being 
struck or run over by automobiles and 935 injured from the same 
cause. There were 77 killed and 171 injured b}^ trolley cars and 110 
killed and 249 injured by wagons, a total of 351 children under 16 
years of age killed and 1.355 injured in one year in only two States 
of the Union on account of being struck or run over by vehicles while 
playing upon or crossing public streets or highways. 



MISCELLANEOUS TOPICS. 91 

D. INTESTINAL PARASITES AND THE RURAL SCHOOL. 

John A. Ferkell, M. D., 
Rockefeller Sanliary Commission^ Washington, D. C. 

Infection by intestinal parasites is AYOrld-wide in its distribntion. 
Tt is most prevalent in the tropical and semitropical countries, wherfe 
it is a problem of great magnitude. As a factor affecting the life and 
the health of the people, their physical and mental development, and 
their material Avelfare, its importance has not been generally appre- 
ciated. In fact, it has not been particularly emphasized by many 
of our medical colleges and of course not by the physicians they 
graduated. Yet in the light of the revelations made during the past 
three or four years by the Rockefeller Sanitary Commission, work- 
ing in conjunction with boards of health of 11 Southern States, 
there should be great reform generally in the methods for acquaint- 
ing both students of medicine and the laity Avith the essential facts 
pertaining to this form of infection. 

Types of parasites. — During the three and one-half years prior to 
July 1, 1913, the health agencies above referred to made 665,581 
microscopic examinations of specimens of feces for parasitic ova for 
665,581 persons; of these 329,578 were found to have hookworm in- 
fection and were treated. Private ph3^sicians have treated and re- 
ported 162,305 additional persons, giving, with those treated b}^ the 
health agencies, a total of 491,833 treated persons. The hookworm 
is by far the most common and most important of the intestinal 
parasites. In 326 counties of the South, infection surveys for hook- 
Avorm disease have been made. Each survey is based on the micro- 
scopic examination of a minimum of 200 country children taken at 
random, ages 6 and 18 years, inclusive. These surveys indicate that 
in different counties, varying with their geographical location, the 
hookworm infection ranges from 1 per cent to as high as 80 or 90 
l^er cent of those examined. 

In many localities 80 to 100 per cent of the school children have 
been found to have the disease and to have made only 50 per cent of 
the progress made by normal healthy children. In other localities 
entire families heavily infected have had their systems so under- 
mined that they were swept away completely, either directly by 
hookworm disease or by intercurrent diseases like tuberculosis, pneu- 
monia, or typhoid fever, which easily OA'er whelm the devitalized 
bodies of hookworm subjects. Routine examinations for a series of 
graded schools have shown hookworm infection three times more 
prevalent in the backward sections than in the advance sections for 
the various grades. 



92 SCHOOL HYGIENE. 

The school in the rural section affords the greatest medium for 
the spread of the infection. Supi^ose we take a certain school district 
in which by chance no infection exists. Now let the son and daughter 
of Mr. Smith visit Mr. Jones, Avho lives in a district where there is 
much hool^v^'Orm disease. While there, fruit of some kind is picked 
up from the ground by the Smiths and eaten, and perhaps in 
going barefooted "gTound itch," the beginning of skin infection, is 
contmcted. The visit over, the Smiths return home. Having no 
sanitary privy on their preraises, the soil around their house is soon 
polluted, so that one by one the whole Smith f amii}^ becomes infected 
in varying degrees of severity. Fall conies, and the neighborhood 
school opens. The Smith children may by this time be a little pale 
and pviBj from the disease, but they start to scliool. The school may 
be in a progxessive neighborhood; it may be painted and furnished 
with patent desks, and perhaps it has secur^ a creditable libraiy^, 
Oood heaters have been provided, the light comes from the rear and 
over the left shoulders of the pupils. Perhaps there is a driven well 
to supply water, but there will be no individual drinking cups, and 
this is not the worst of it. No privy has been provided; but why 
should there be ? The pupils, not having one at home, do not think 
of having one at school, especially since the woods and undergrowth 
are near the schoolhouse. The girls, hj custom, conceal themselves 
when answering nature's call in the woods on the east side and 
tlie boys on the west. The Smith children do not know they 
are infected. The}^ use the connnon hiding grounds with the 
other children. Soon the whole school grounds are so heavily pol- 
luted that on damp days every pupil who goes around barefooted 
will contract " ground itch," and, moreover, those who play ball, 
marbles, mumble-the-peg,etc., get their hands infected. Facilities for 
washing the hands are not available; so at lunch time they handle 
their food with soiled hands which are likely to be contaminated. In 
this way the pupils at school become infected. In a comparatively 
short time the premises around the homes of all the school children 
are polluted, and you have a change which anemia produces coming 
over the eonnnunity. Progress of the children in the school is re- 
tarded; the daily attendance is poor; the health of the community 
is below normal; the crops are not so well cultivated; and there is a 
general backward tendency. The houses are not so well provided for 
or kept. The whole community is sick and doesn't know it. The 
economic loss is tremendous. Delay in establishing control of infec- 
tion spread by such filthy habits is criminal, once the facts are 
known. The victims are ignorant of the facts. Teaching them is a 
duty of every informed citizen, board of health, and physician; yet 
these agencies are not sufficient to reach the masses. 



MISCELLANEOUS TOPICS. 93 

The common schools throiiiih the school children can reach practi- 
cally every home. Hence, an important part of this work should be 
directed to the teaching of sanitation, dealing particularly with 
parasitic intestinal infection and other infections spread by soil 
pollution. The school should be an institution where methods are 
taught for saving and preserving the child, for making him a 
healthy educable child, one who will bless the State with the 
highest type of citizenship. May we not hasten a reform which will 
make the school a place where the teachings of sanitation are put 
into practice and not a center for exchanging and spreading all 
kinds of filth-borne diseases? 



PART III. THE SCIENTIFIC EXHIBIT. 



CONCRETE DATA OF THE SCHOOL HYGIENE MOVEMENT 
AS SHOWN IN THE EXHIBIT. 



I. MEDICAL INSPECTION. 

Boston, Mass. — The division of child hygiene is concerned with 
the physical welfare of every child in Boston from the time of con- 
ception up to the age of 16 years. The work of this division is 
classified into three subdivisions, as follows: (1) Prenatal and post- 
natal; (2) medical inspection of schools; (3) physical examination 
ef licensed minors. 

Phj^sical examination of school children for the year 1912-13 
showed the following results : 

Total number of pupils examluecl 121, 832 

Total number of pupils without defects 52,499 

Total number of pupils with defects 69,333 

The defects noted were : Mental deficiency, 391 ; defective nasal 
breathing, 9,174; h3q3ertrophied tonsils, 24,720; defective teeth, 
60,709; defective palate, 366; cervical glands, 11,370; pulmonary 
disease — tuberculous 66, nontuberculous 1,165; cardiac disease, 2,796; 
nervous disease, 303; orthopedic defect — tuberculous 103, nontuber- 
culous 3.154; skin disease, 3,768; rickets, 644; malnutrition, 2,620. 

Buffalo^ N. Y. — Medical school inspection in Buffalo is divided into 
four general divisions: (1) Prevention of communicable diseases; 
(2) detection and removal of physical defects; (3) child psycho- 
physiology; (4) sanitary condition of the school buildings and 
environments. 
04 



THE SCIENTIFIC EXHIBIT. 

The folloAviiig i< a resume of some of the work: 

Report of medical .school c-i<iniinci\ year 1912. 



9S 



Number examined 

Malnutrition 

Anemia 

Enlarged glands 

Goiter 

Nervous diseases 

Cardiac disease 

Pulmonary disease 

Skin disease 

Defect, orthopedic 

Kachiiic type 

Defect of vision 

other diseases of eye 

Defect of hearing. ". 

Discharging ear 

Defect of nasal breathing 

Defect of palate 

Defect of teeth 

Hypertrophied tonsils. .. 

Adenoids 

Mental cases 

Treatment advised 



Girls. 


Boys. 


23.263 


24.727 


468 


392 


617 


459 


623 


789 


106 


33 


116 


98 


112 


111 


74 


80 


387 


247 


84 


128 


81 


62 


2.042 


1.763 


231 


210 


140 


200 


81 


54 


723 


1.259 


73 


58 


11.204 


12. 032 


3.239 


3.197 


233 


344 


72 


124 


1.080 


1.194 



TotaL 



47. 990 
860 

1,076 

1.412 
139 
214 
223- 
154 
634 
212 
14S 

3.805 
441 
340 
135 

1,982 

131 

23.236 

6,43& 
577 
19ff 

2,274 



Cincinnati Ohio. — The bureau of medical inspection and relief is 
organized with the following officers: Chief school inspector, with a 
salary of $1,800; 16 district physicians, 11 on full time and 5 on part 
time, to whom a total salary of $18,275 is paid; 11 school nurses, 
$10,920; 1 chief dental inspector, $1,500; 4 dental operators (part 
time), $2,000; 2 clinical assistants, $1,100; 1 clerk, infectious diseases, 
$1,000; 1 clerk, tuberculosis records, $800; fumigator, $900; 1 chief 
medical inspector and assistant health officer, $2,750. Their functions 
are : School inspection, medical relief of the poor, surveillance of in- 
fectious diseases. 

The hours of medical inspection are 9-12 a. m., 2-3 p. m. Twenty- 
two public schools and 35 parochial schools, a total of 57, have medical 
inspection only, without the school nurse. In 43 public schools and 
12 parochial, a total of 55 schools, both doctors and nurses are em- 
])l()3^ed. The average number of pupils for each nurse is 2,350. 

During the period from September 10, 1912 to June 19, 1913, the 
school doctor handled the following cases: 

Exclnded on acconiit of iufectiou disease or contact 113 

Inspected after 4 days' absence 6,331 

Examined but not needing treatment 13, 537 

Keceived for treatment 14.679 

Total number of examinations of cliildren 35. 578 

In the same period the school nurses* activities were as follows: 

Xumber of cases referred to nurses S. 874 

Treated by family physician 1. 9S5 

Treated by clinics and hospitals 2.902 

Pediculosis and minor cases treated by nurses 2, 811 

13011°— 13 7 



96 SCHOOL HYGIEXE. 

Cases refused treatment and pending 1,076 

School treatments given 8.053 

Home visits 4. 731 

" The nurse is the connecting link between school and home.'' 
A survey of 36,438 pupils in public schools, April 21 to June 6, 
1913, showed: 

Number. Per cent. 

Tnberculons 84 0. 23 

Pretuberculons 505 1. 38 

Anemic simply 1.030 2.83 

Total anemic 1.619 4.44 

Mentally retarded (x)7 1. 80 

This is urged as an argument for (1) more open-air schools anel 
low-temperature rooms: (2) new school for mentally deficient chil- 
dren. 

Among defects diagnosed by school phj^sician were : Defective 
vision, 2,135: diseases of the eye, 298. Of these, 1,092, or 44.9 per 
cent, were corrected by glasses and treatment. Hypertrophied ton- 
sils, 2,692 cases noted, operative, 642; medical, 650, a total of 1,292, 
or 48, per cent treated. Defective teeth, exclusive of dental inspec- 
tion, 1.754; cases finished, 1.002, or 57 per cent. Medical and surgical 
miscellaneous, 1,9^6; treated, 1,501, or 75 per cent. Children inocu- 
lated against smallpox, September 10, 1912, to June 19, 1913, 4,686; 
of these 97.3 per cent were successful, 52 were unsuccessful, and 76 
unknown. 

Detroit, Mich. — Results of medical ins^Dection of schools, Septem- 
ber, 1912, to June, 1913: 

Number of pupils examined 95,542 

Number of pupils excluded 4, 752 

Number of pupils vaccinated 6, 466 

Number of defects found 6,062 

Nurses' visits to bomes 7.081 

Nurses' visits to schools 4,193 

Nurses' visits to dispensaries 432 

Total visits 11, 706 

Attendance at school clinics 27.228 

Ctiildren treated at home — _ 252 

Children treated at dispensaries 1.038 

Instruction to mothers 5,348 

Eight nurses were employed at a total expense of $4,800, and 33 
doctors ($11,500), or a total cost of $16,350. 

JacJt'SonmUe^ Fla. — Medical inspection of school children in Jack- 
sonville, Fla., showed that 77.1 per cent of all the children examined 
were defective in one or more particulars. The following are the 



THE SCIEXTIFIC EXHIBIT. 97 

percentages for the various defects: Hypertropliied tonsils, 36.6 per 
cent : defective vision. 25.8 per cent : enlarged cervical glands, 9.1 per 
cent; adenoids, positive, 5.2 per cent: nasal breathingj 3.8 per cent; 
skin diseases, 2.5 per cent; hookworm, positive, 2.3 per cent: mal- 
nutrition, 0.85 per cent; anemia, marked, 0.8 per cent: defective hear- 
ing, 0.65 per cont; ccnjiinctiviti*^, 0.2 per cent. 

Xeic Tori'. X. Y. — The work of the division of child hygiene is 
thus outlined: 

(1) Inspection for the determination of infectious diseases; (2) in- 
spection and treatment of contagious eye and skin diseases in school; 
(3) examination of pupils for certain physical defects: (4) follow-up 
visit by nurse to home to secure treatment for noncontagious physical 
defects; (5) treatment at clinics for eye, ear, nose, and throat; 
(6) treatment of teeth at dental clinics. 

School medical inspection is organized imder a director and assist- 
ant director for the entire city, with a separate organization for each 
of the five boroughs in charge of a borough chief insi3ector. Under 
each borough chief is a corps of supervising inspectors and super- 
vising nurses, who direct in turn the routine medical insj)ectors and 
school nurses. In the year 1912-13 there were 825,664 children in 
public and parochial schools of Xew York City under medical 
inspection. The cost of carrying on the work was $364,300, or -11: 
cents per capita. The chief medical inspector for each borough has 
oversight of the clinics for school children. 

Philadelphki. Pa. — The scope of the work of the department of 
medical inspection of schools is described as follows: (1) Detection 
and correction of physical defects; (2) detection and exclusion of 
contagious disease cases; (3) sanitary inspection of school buildings; 
(1) examination at their homes of absentee children, in order to 
determine whether such children should be excused from school; 

(5) the examination of applicants for the position of school janitor; 

(6) examination of high-school boys entering into athletic contests: 
(T) a clinic for the exa-mination of mentally deficient children; 
(8) special medical supervision of three open-air schools; (9) free 
vaccination of school children. The organization is as follows: 
(1) Public schools, medical inspection (under bureau of health and 
board of education) : (2) public schools, nurses (board of education 
and bureau of health) : (3) private schools and parochial schools, 
medical inspection (under bureau of health) ; (4) eye dispensar}^ 
for school children, Xo. 1 (for all school children), under bureau 
of health; eye dispensary for school children, Xo. 2 (public school 
children), btireau of health and board of education; (5) dental 
dispensary for school children, Xo. 1, for all school children (under 
bureau of health) ; dental dispensary for school children, Xos. 2, 



98 SCHOOL HYGIENE. 

3, 4, for i)iiblic school children, under bureau of health and board 
of education. 

A general summary of medical inspection in Philadelphia for 1912 
shows : 

Number of pupils in elementary schools 175,905 

Nmiiber of pupils in high schools 11,502 

Number of school buildings 280 

Visits made by supervisors 1,355 

Visits made by assistant Inspectors 35, 556 

Pupils sent to inspectors by teachers 98,171 

Routine physical examinations 111,854 

Special examinations (classrooms) 317,564 

Defects recommended for treatment 138,092 

Proportion of physical defects corrected percent 45 

Exclusions from school 7,046 

Time lost from school by reason of exclusions, minor contagious dis- 
eases only days-- 4, 314 

Number of throat cultures taken 2,722 

Number of throat cultures with positive results 418 

Vaccinations performed 2,312 

The following is a table showing physical defects recommended for 
treatment at two different periods : 

Feb.-Dec, Jan.-June, 

Defects : 1912. 1913. 

Eye - 25, 656 16, 510 

Nose, throat, and mouth 37,088 22,946 

Ear 2, 249 1, 470 

Teeth 50]^ 047 40,345 

Orthopedic 2, 049 1, 686 

Anemia and poor nutrition 2,543 1,434 

Nervous 935 670 

Heart. 367 587 

Defective mentality 163 188 

Skin 19, 385 10, 144 

Miscellaneous 2, 054 2, 552 

Total 142, 536 98, 502 

Republic of Mexico. — Mexico has had medical inspection of schools 
since 1896. Begim in a small way in that year, it Avas considerably 
extended by an act of 1908. Annual salaries and expenses for the 
work increased from $2,000 in 1896 to $52,000 for the year 1912-13. 
During the same period the number of medical inspectors has in- 
creased from 1 during the first three years to 43 in 1913. About 
5,500 children are now assignee! to each school doctor. 

Of diseases found in school children in Mexico City 1908-1912, 
those of contagious type most frequently found are pediculosis (15 
per cent) and ringworm (4J per cent). In the noncontagious diseases 
anemia led AA^ith 19 per cent ; 29 per cent of the children haA^e defec- 
tive Adsion, 27 per cent dental caries, and 5J per cent defective hearing. 



THE SCIEXTIFIC EXHIBIT. 99 

n. THE SCHOOL NURSE. 

Buffalo, X. Y. — Scliool nurses in 1912 made 1.703 school A'isits and 
2,01-i home visits, of which (>00 were to contagious and 1.414 to non- 
contagions cas€s. Total inspections were 19.411. 

Treatment or instruction was given as follows: Pediculosis, 1.3G4 
cases ; ringworm. 40 ; f avus. 13 ; scabies, 184 ; impetigo, 470 ; skin, 
1.201: eyes. 1.398: ears. 5G4; vaccinations, 379; miscellaneous, 2,381; 
dispensary, 43. 

PI ill ad el phi o.. Pa. — The bureau of health of Philadelphia shows 
the direct value of the school nurse service by comparing conditions 
with and without nurses. A saving of nearly five days is obtained 
on every case of contagious disease by means of the school nurse 
service. The statistics shoAV that the average number of days lost 
by school children when the schools are without school nurse service 
is 5.06458. The average number of days lost when the schools have 
nurse service is found to be 0.34268. Lack of nurse service is there- 
fore responsible for 4.72191 days of preventable loss. Multiplying 
4.72191 (preventable) loss (average days) by 16.884 cases of minor 
contagious diseases handled by school nurses gives 79,725 total days 
of school time saved to tiiese school pupils through nurse service. 
The per capita cost of education in Philadelphia is 18^ cents, so that 
$9,122.05 is saved to the educational system through this one branch 
alone of the school nurses' activity. The total cost of school nurse 
service from February, 1912, to Jime, 1913. was $25,760. The .nurses 
were employed in the congested districts of the city. 

Another proof of the importance of the school nurse is found 
in the follow-up results. Irrespective of social grade, more physical 
defects are corrected with nurse than without. Four groups were 
studied: In group white, native, social grade A, 43 per cent of de- 
fects were corrected with nurse, as compared with 36 per cent when 
310 nurse was employed. In group Avhite. grade B, 50 per cent were 
corrected with a nurse, and 43 per cent without. In white, grade C, 
50 per cent were corrected when a nurse was employed, whereas only 
18 per cent were corrected when there was no nurse. In colored, 
grade C, 63 per cent of defects noted were corrected with the nurse, 
as against 22 per cent Avithout a nurse. 

Rochester, A. Y . — School nurse,^ in Rochester paid 1.269 visits to 
homes: took 853 cases to dispensaries and hospitals: cared for 1.906 
defects ; found 306 defects of eyes ; 461 of ears, nose, and throat ; 273 
of teeth; 267 skin diseases: 413 miscellaneous defects. 



100 SCHOOL HYGIENE. 

in, ORAL HYGIENE. 

Connecticut, — In Hartford there are free dental clinics for school 
children supported by the Hartford dental society. In Waterbury 
there are two dental inspectors, salary $600, paid by the city. In 
Bridgeport ih^ city appropriates $500 for the dental clinic of the 
Bridgeport dental society. New London has a dental clinic equipped 
by the board of education and maintained by the Xew London dental 
society. Other Connecticut towns report as follows: Stratford — 
examination by an individual dentist, but no town appropriation; 
New Britain — examination of the children by the New Britain dental 
society; Greenwich — clinic established by the United Workers; New 
Haven — room secured in a school building for-a privately supported 
clinic; Meriden — school children examined by the Meriden dental 
society, but no appropriation. 

Kentucky. — Dental inspection and clinics in 17 communities 
throughout the State. 

New York, — The State department of health is conducting an 
active oral hygiene campaign by means of elaborate exhibit material, 
which includes a model clinic. 

Pennsylvomia. — Thirteen free dental dispensaries are in operation. 
Besides the 5 in Philadelphia, there are 2 each at Pittsburgh and 
Wilkes-Barre, and 1 in each of the following cities: Scranton, Phil- 
ipsburg, Beading, Chester. 

Boston^ Mass. — The Forsyth Dental Infirmary, Boston's answer to 
the oral hygiene problem, is to be opened in 1914. Its work will be 
to care for the mouth conditions of all the children of Greater Boston 
lip to 16 years of age. Attention will be given to adenoids, hair lip, 
tonsils — in short, the whole subject of mouth, nose, and throat. 
Follow-up work will be done by the school nurse and social secretary. 
Patients will be required to return to the infirmary three or four 
times a year for examination, treatment, and advice. The institu- 
tion will have facilities for 64 chairs, with room for 44 additional; 
each chair having a capacity of 12 patients per 8-hour day, or a total 
capacity of 768 patients daily. There will be a lecture room for 
public lectures on hygiene and oral prophylaxis. 

Cincinnati^ Ohio, — Mouth hygiene is supervised in Cincinnati 
through a cooperative arrangement between the Cincinnati dental 
society and the board of health. The board of health provides 1 
chief dental inspector, 4 dental operators, and 2 clinical assistants. 
The dental societ}^ furnishes 56 dental inspectors and 39 lay volun- 
teers. The number of children examined in different years was: 
920 in 1909; 4.594 in 1910; 8,432 in 1911; and 12,660 in 1912. 



THE SCIENTIFIC EXHIBIT. 



101 



Fillings 

Treatments 

Cleaning 

Crowns 

Extractions 

Total operations 
Number of cases. 



Operations. 



1910. ' 1911, 
Sept.-Dec. 10 mos. 



763 
334 
192 
3 
256 
1,548 
210 



2,654 
1,335 

515 
10 

790 
5,214 

790 



1912, ; 1913. 
10 mos. i Jan. -July. 



1,789 
1,455 

476 
8 

961 
4,689 

972 



3.952 
1,720 
1,047 
8 
1,555 
8,282 
1,379 



Follow-up work in two typical schools: 

First school. ] 



Second school. 



Number inspected 664 

No defects 74 

Treated at dental clinic 125 

Treated by family dentist 290 

No treatment 120 

Withdrawn from school 55 



Number inspected 32G 

No defects 22 

Treated at dental clinic 99 

Treated by family dentist 116 

No treatment 8 





Expenses of the free clinic. 








\ 1910, 
; Sept. -Jan. 


1911, 
Sept.-Jan. 


1912, 
Sept.-Jan. 


1913, 
Jan.-July. 


Equipment 

Salaries ... 


■ S518.78 

526.00 


S10.25 

1,445.00 

151.00 

78.50 

11.40 


S13.63 

1,674.00 

112.39 

74.27 
104.80 


S541.71 

2,510.82 

28:3.84 

46.17 

5.05 


Supplies 

Office 

Education 


74.97 

77.47 

93.80 



Cleveland. Ohio. — In 1910-11 Cleveland was the scene of the na- 
tional mouth-liTgiene campaign. The National Dental Association 
sux^plied equipment for clinics, a trained nurse and finances for the 
Marion School class. The Ohio State Dental Association paid for the 
printing and furnished the use of a stereopticon. The Cleveland 
dental society furnished the examining clinicians and lecturers. 
Kooms were furnished by the Cleveland board of education, by the 
library, and by St. Alexis Hospital. The campaign had for its object : 

To bring to tlie attention of tlie people, by means of dental inspection of an 
adequate number of children, tbe universal need of dental service; to show 
by means of clinics that there is a great demand for dental service by indigent 
children; to present to the people by means of lectures the great value of 
mouth hygiene in the general welfare of the child ; to show by means of the 
Marion School class the results possible to be obtained from an ideal method of 
instruction in the care and use of the mouth, accompanied by the correction of 
the faulty oral condition. 

As a result of this campaign, 20,861 pupils were examined. The 
.mouths of 97 per cent were found faulty. The six clinics were oper- 
ated for a total of 331 half-days: 372 patients were treated; 2,217 
operations were performed; and 19 lectures were delivered at the 
various school auditoriums to parents of the older grade pupils. 

From a school of 816 pupils there were selected 10 children pre- 
senting the most faulty oral conditions. 27 of whom acquiesced in 
the plan, followed instruction, and took the tests. The children vrere 



102 SCHOOL HYGIENE. 

oacli given a toothbrush, tooth poATcler. and a drinking glass. A 
dental nurse trained them to clean properly the teeth and mouth and 
visited their homes to see that the instructions were carried out. The 
children were given special instruction in the use of the mouth in the 
home and by specimen meals in school. The faulty oral conditions 
were corrected in the clinics. Psychological tests under an expert 
demonstrated the mental as well as physical improvement due to 
remedying bad mouth conditions. 

Detroit^ Mich. — An appropriation of $5,000 was allowed for dental 
inspection and clinics from September 1, 1912 to July 1, 1913. Four 
dentists examined 50,000 pupils; 12,000 patients were treated in five 
clinics ; and there were 40 lantern-slide lectures in school. 

For the 3^ear 1913-14, $8,000 has been appropriated. There will 
be six inspectors and seven clinics, and twice as many lectures on 
mouth h^^giene as last year. 

Los Angeles^ Ccd. — The board of education has now taken over the 
dental clinic formerly maintained by the Los Angeles parent-teacher 
association and the county dental society. During the past year 
(1912-13) there were two full-time operators; 1,434 patients were 
treated. 

Philadelphia^ Pa. — The city maintains a complete system of dental 
inspection and clinics as a separate division under the bureau of 
health. The work was organized in the fall of 1910 on a volunteer 
basis, and remained so for one year, the city supplying the oiRces in 
city hall and equipment for three chairs and one nurse. In January, 
1912, eight paid dentists were engaged. In February, 1912, the first 
school branch opened. In December, 1912, four additional assistants 
and one chief were engaged, and in 1913 two additional school 
branches were opened. The appropriation for 1913 provides as 
follows : 

Twelve operators, each serving three hours per day. at $700- $S. 400 

Equipment for two schools 1,200 

Maintenance 500 

ZS^urse at central office 800 

Chief of division 2.500 

The school board at present bears no expense except plumbing and 
electric current. 

The work of one of the clinics from Januar}^ 1 to June 30. 1913 : 

Patients. Operations. 

January 757 2, 328 

February 665 2, 095 

March 674 2, 185 

April 945 2, 794 

May 828 2,534 

June 590 i, 780 

Total 4. 459 13, 716 



THE SCIENTIFIC EXHIBIT. 



103 



Girai'd College has a department of dental surgery, i»ecently or- 
ganized, which has for its sole object and aim the care of the teeth 
of the boys in Girard College. The department is under the care 
of a dentist in chief, two assistant dentists, and a clerical and me- 
chanical assistant, all of whom are employed full time. 

Rochester. xV. Y . — A free dental clinic, claimed to be the first in 
the world, was established in Eochester more than 25 years ago. 
It Avas closed after two years for lack of support. The first American 
school dental dispensary was established in Eochester in 1905 by the 
Eochester Dental Societ}^ Dental dispensaries are now operated in 
schools Xos. 26, 12, and 14. In 1912, 2,101 patients were treated, 
involving 11,137 operations. The total cost was $2,461.16, or $1.12 
for each child. 

Toronto^ Canada. — Lee School, of Toronto, claims the distinction 
of having pupils absolutely without a caiious tooth or an unclean 
mouth. The pupils are all from the Girls' Home, where daily care 
of the teeth is part of the routine. 

Relation of dental hygiene to mental e-fficienr-y. — Dr. J. E. W. 
^Vallin has measured with selected test materials the increased mental 
efficiency of children whose oral defects have been remedied. In 
memorizing 3-place digits there was an average gain in those under 
observation of 19 per cent in efficiency ; in the spontaneous association 
test the average efficiency gain w^as 42 per cent; in adding 1-place 
digits, 35 per cent ; in the antonym test. 129 per cent ; and in the test 
of canceling a's there was an average gain due to dental improve- 
ment of 60 per cent. 



IV. OPEN-AIR SCHOOLS. 

Horace Mann School^ New Yorh^ N . Y . — Two third-grade classes, 

as similar as it was possible to have them, were compared for a 

period of six months. One class was an outdoor class, the other 

a regular indoor class. The two classes were compared in respect 

both to physical improvement and mental improvement, with the 

following results: 

PJiysicdl improvemeut. 



Average age at beginning of tests 

Duration of tests 

Average gain in— 

Weight 

Height 

Girth of chest 

Girth of cliest expanded 

Breadth of chest 

Depth of chest 

Lung capacity 

Strength, right arm 

Strength, left arm 

Strength, upper back 

Strength, chest 



Indoor. 



8 yrs. 6 mos 

Oinos 

1.6 kg. or 3.5 lbs 

2.6 cm. or 1.0 in 

1.3 cm. orO.o in 

1.0 cm. or 0.6 in 

0.9 cm. or 0.37 in 

0.0 

8.0CU. in 

1.4 kg. or 3.0 lbs 

1.4 kg. or 3.1 lbs 

2.0 kg.or 4.4lbs 

2.8 kg. or 6.2 lbs 



Outdoor. 



8 yrs. 4 mos. 
6 mos. 

1.7 kg. or 3.7 lbs. 

2.8 cm. or — in. 

1.8 cm. or 0.74 in. 
1.7 cm. or 0.7 in. 
0.2 cm. or 0.07 in. 

— 0.4 cm. or — 0.13 in. 

5.9 cu. in. 

0.8 kg. or 1.7 lbs. 

2.1 kg. or 4.5 lbs. 
2.0 kg. or 4.4 lbs. 

3.2 kg. or 7.0 lbs. 



104 



SCHOOL HYGIENE. 



Indoor class improved more in four of these measurements. Out- 
door class gained more in six of these measurements. Classes gained 
the same in strength of back. Outdoor class gained more in height, 
weight, and girth of chest. 

Mcutal improvement. 



j Number of 
pupils. 



Average. 


Dec. 12. 


May 13. 


Per cent. 


Per cent. 


\ - 


57 


} 35 


48 


}, .s 


68 


1 69 


75 



Improve- 
ment. 



In formal English: 
Open air 

Indoor 

In arithmetic: 
Open air 

Indoor 



/18in Dec 

\12inMay 

/22 in Dec. . . .-. 
\27 in May 

fl4 in Dec 

\22 in May 

/28 in Dec 

\24 in May 



Per cent. 
20 

13 
20 



Elizaheth McCormich Memorial Fimcl^ Chicago^ III. — The Eliza- 
beth McCormick Memorial Fund was established in 1908. Its gen- 
eral object is "to improve the condition of child life in the United 
States." One of the chief special objects is: "To promote, in an ex- 
l^erimental wa}^, open-air schools by maintaining in Chicago schools 
like the Elizabeth McCormick open-air schools, and by standardizing 
the methods of such schools." The fund gathers information on 
open-air schools and other child welfare agencies, and disseminates it 
for the. guidance of citizens and legislators. " Open- Air Crusaders • ' 
is the title of an attractive report that sums up the open-air work. 
The exhibit at Buffalo consisted mainly of apparatus for open-air 
y/ork: Cot, clothing, etc. 

Cincinnati^ Ohio. — A typical woodland school for pretuberculous 
and anemic children is maintained by the board of education for 
children of grades 1-5. The school was established in 1911 on the 
principle that "education without health is useless." The cost has 
been 19 cents per pupil per day. Children w^ith tubercle bacilli in 
sputum are not admitted to this school. 

In the regular open-air school the board of health furnishes a 
nurse and medical director and equipment for 25 pupils. The build- 
ing cost $1,266 and the equipment $600. The average cost for main- 
tenance was $2.35 per week per child. Temperature, pulse, and res- 
piration are recorded daily at 8 a. m. and 3 p. m. Hsemoglobin tests 
are given upon admission and whenever indicated. The treatment in- 
cludes a warm cleansing bath and cold showers daih^ (special cases 
excepted). It is significant that on Friday the pupils show a marked 
gain, and on Monday a slight loss. The children are fed inspected 
milk and crackers morning and afternoon. There is a dinner, with a 



THE SCIENTIFIC EXHIBIT. 105 

specified menu for eacli day, prepared by the domestic science de- 
partment. Tlie total expense per child for food is 17 cents. 

From September 10 to June 6, 1913. the average gain per pupil in 
weight was 6.2 pounds. Every child gained in weight. Two girls 
gained 12 pounds 12 ounces, 1 girl 11 pounds 12 ounces, another 10 
pounds 12 ounces, and another 9 pounds 10 ounces. The average 
daily attendance in 1911-12 in the open-air school was 96.9 per cent, 
as compared with 95.1 per cent in a typical elementary school of the 
regular type. 

Oaldand. Cal. — The report of the commission declares: "In each 
new building there shall be at least one open-air schoolroom that can 
not be entirely closed. In all new buildings provision shall be made 
whereby every classroom may be easily transformed into an open-air 
room." 

Chicago^ III. — There are at present in the Chicago public school 
system four open-air and six open-window, or low-temperature school- 
rooms. The open-air rooms are conducted upon roofs with little other 
than overhead protection, while the open-window rooms are in regu- 
lar school buildings, with the rooms and conditions adapted to meet 
the needs of undernourished and tubercular children. In the sum- 
mer term these children are taught out of doors, in tents erected in 
the school yard at the various schools. 

Other cities. — Cleveland, Buffalo, New York, Newark, X. J., Eoch- 
ester, and Philadelphia are other cities which have made notable 
efforts to incorporate the open-air idea into their school system and 
exhibited some of the results of their experiments at the congTess on 
school hygiene. 



V. SCHOOL FEEDING. 

History and present status. — The American Home Economics Asso- 
ciation shows that the school feeding movement is by no means a 
new thing. School feeding began in Germany in 1790 ; France, 1819 ; 
Great Britain, 1866; and in the United States in 1895. Seventy- 
seven cities in this country now maintain school lunches (1912). 
Lunches are also served regularly in special and open-air classes in 
a number of cities, among them being Philadelphia (special class) ; 
New York (undernourished children) ; Syracuse (open-air school) ; 
Newark (open-air school) ; Cleveland (fresh-air class) ; Buffalo, 
X. Y. (open-air school). The claim is made that 10 per cent of the 
children in our cities suffer from malnutrition. 

In all the school feeding work emphasis is laid upon the increased 
food value resulting from school lunches supervised by a dietician. 
It has been estimated that children in the cities of New York, Chi- 
cago, Philadelphia, Boston, St. Louis, Baltimore, Cleveland, and 



106 



SCHOOL HYGIENE. 



Pittsburgh spend a total of $1,554,000 for lunches every year. This 
amount will buy on the street the equivalent of 81,000,000 calories of 
food value; while at the school lunch it Avill purchase 178,000,000 
calories. Typical school and street luncheons are compared as fol- 
lows : School lunch, consisting of cocoa and wdiipped cream, 3 cents ; 
egg sandwich, 4 cents; banana, 1 cent; four dates, 1 cent; three 
cookies, 1 cent ; gives a total of TOO calories food value for 10 cents ; 
while in the street three crullers and a cup of coffee, costing 10 cents, 
furnish a food value of only 250 calories. 

High-school children in Philadelphia spend $92,000 for lunches; in 
St. Louis, $57,423; in Boston, $52,721; in Kochester, $18,760. The 
cost of kitchen administration for Boston, Mass., and Bradford, 
England, are contrasted as follow^s: 





Cost of kitchen (Khninist ration (per cent). 






■ 


Food. 


Delivery. 


Labor. 


Rent. 


other 
expenses. 


Boston . . 


54.2 
54.0 


4.2 

17.6 


32.4 
18.0 


1.4 
2.2 


7 8 


Bradford, England : 


7.5 



Cincinnati, Ohio, — School lunches in Cincinnati are in charge of 
" The penny lunch association," whose members are made up from 
the Civic League, the Council of Jewish Women, and the civic de- 
partment of the Woman's Club. Eleven penny lunchrooms are 
maintained in congested districts. The kitchen equipment and the 
pay of the cook are provided by the board of education. " Once 
started, the penny lunchroom is self-sustaining," according to the 
Cincinnati experience. A different menu is provided for each day 
of the week. The benefits as observed in Cincinnati are : The penny 
lunch improves general health and increases mental efficiency; the 
child learns to appreciate the value of good food and disseminates 
the knowledge of selection and preparation of wholesome food in 
the home. In the Pioneer Penny Lunchroom, established in 1908, 
50 penny luncheons are served daily. 

Chicago, III, — Three penny-lunch centers have been in operation 
in Chicago since December, 1910. During the school year 1910-11 
the entire expense of these luncheons was borne by the board of 
education, but in November, 1911, the permanent school extension 
committee of the Women's Clubs undertook their management. A 
suitable room, with janitor service, one paid attendant, and a com- 
plete equipment are provided by the board of education. The 
school extension committee provides a trained supervisor, who pur- 
chases the food, plans the meals, and sees that they are properly 
cooked and served. At each center volunteers from the various 
women's clubs assist in serving the luncheons. The following menus 



THE SCIENTIFIC EXHIBIT. 107 

have been served during the past jeixv on successive days: Cocoa, 
bread, and sirup; vegetable soup, bread, and jam; meat, soup, bread, 
and sirup ; split pea or bean soup, bread, and sirup. Due regard is 
paid to national tastes or religious requirements. 



VI. SEX HYGIENE. 

Chicago^ III. — By resolution of the Chicago board of education : 
Specialists iu sex liygiene wbo lecture in simple, yet scientifically correct, 
language are to be secured to give during the year 1913-14 a cotirse of 3 
lectures on sex hygiene iu each of the 21 high schools, the pupils to be grouped 
in reasonable numbers, boys and girls separate; provided that all pupils who 
bring notes from their parents asking to have them excused shall be excu.sed ; 
that after December, 1913, the lectures be limited to first-year classes in hygiene 
or biology. 

Part of the original resolution also provided for certain sex in- 
struction to children in groups in the middle and upper grades of 
the elementary schools, but action on this has been deferred, to a^vait 
the result of the experiment Avith high-school pupils. The Chicago 
board has also provided for appropriate sex instruction through paid 
lecturers to parents of school children. 

Plan for sex education. — The Child-welfare Exhibition Commit- 
tee, showing panels based on the recommendations of the American 
Federation for Sex Hygiene, outlines the following plan : 

Answer honestly when the child of even 3 or 4 years asks, " Where 
did baby come from ? " A true but simple statement about mother 
and baby if given at this time may keep the child from picking up, 
when older, false and unclean ideas from street companions. 

From 6 to 12 years children can be interested by parent or teacher 
in nature study. Let children of this age observe the life and repro- 
duction of plants and animals. Their questions are natural. Con- 
cealment breeds curiosity. Answer them frankly. Treat sex and 
reproduction as a natural and pure phase of life. You will receive 
frankness and confidence in return. Young children's thoughts of 
sex are pure until their minds have become contaminated. Sex 
knowledge from pure sources is the best protection against such con- 
tamination. At about the age of 12 the child's sex interest becomes 
more personal and needs not only pure and honest frankness, but also 
direction tovrard self-respect, honor, chivalry. The sex instinct thus 
directed becomes the ally of idealism, altruism, aspiration, religion. 
Religious and moral training are a profound influence at this age 
and must help direct the sex instinct. Physical exercise, intellectual 
interests, and wholesome amusements furnish occupations for mind 
and body and are at this age wholesome and necessary.^ 

1 For a detailed analysis of the plan of the American Federation of Sex Hygiene, see 
Bureau of Education bulletin, 1913, No. 18, pp. 35-38. 



108 SCHOOL HYGIEN^E. 

Venereal disease in Bnffalo. — In order to show tlie need for instruc- 
tion in sex hygiene, the Bnffalo Society of Sanitary and Moral Pro- 
phylaxis has collected fignres shovring the extent of venereal disease in 
Buffalo: Reported by 123 physicians. 1.113 cases; estimated by 330 
others, 2,983; treated by patients, 794; total for November, 4,800; 
total for year 1911 (estimated), 14,423 cases. There were also direct 
infections of children nnder 16 years as follows: Reported by 122 
physicians, 85 cases ; estimated by 330 others, 178 cases ; total, 263. 



Vn. EXCEPTIONAL CHILDREN. 

Psychological clinics, — According to the National Child-welfare 
Committee, the following States have psychological clinics in connec- 
tion with universities and normal schools: Washington, California 
(2), Colorado, Kansas, Minnesota, Iowa, Louisiana, Michigan, Ohio 
(2), Pennsylvania (2), New York (2), Connecticut, Massachu- 
setts (2). 

Three States, Indiana, New York, and Massachusetts, have hospi- 
tals where psychological clinics are established, Illinois and Con- 
necticut have such clinics in connection with juvenile courts. In 
one or more places in the following States the psychological clinics 
are in connection with the public schools: New York (2), Pennsyl- 
vania, Illinois. 

Psychological clinics exist in connection with institutions in Minne- 
sota, Illinois, Pennsylvania, New Jersey, Ncav York, and JNIassachu- 
setts. Ohio has a psychological clinic in connection with a vocational 
guidance bureau (Cincinnati). 

The first psychological clinic was established at the laboratory of 
psychology. University of Pennsylvania, in 1896. 

The resources of a psychological clinic are summed up as follows: 
Psychologists trained in clinical diagnosis; examining physicians 
familiar with developmental diagnosis ; social-science department for 
follow^-np work and for cooperation with individual homes, schools, 
hospital, child-welfare agencies and institutions; accurate and com- 
plete clinical records: summer classes for observation; hospital 
schools for cases needing extended observation and care. 

The psychological clinic studies each child on the following plan: 

(1) History — ^birth, babyhood, childhood, school, disease, parents; 

(2) physical examination; (3) psychological examination; (4) visit 
to and report on home; (5) continuing observation, study, diagnosis, 
treatment as required and as long as required. 

/School of education, University of Pittshurgh. — The school of edu- 
cation, University of Pittsburgh, undertakes the following activities, 



THE SCIENTIFIC EXHIBIT. 109 

which may be taken as tj^pical of the newer psychological- 
pedagogical work: 

1. Conducts a psychological clinic for the Pittsburgh district, for 
the examination and classification of backward, feeble-minded, epi- 
leptic, insane, speech-defective, senae-deprivative, and precocious in- 
dividuals. 

2. Advises parents, teachers, or attendants as to the proper mental, 
pedagogical, hygienic, and institutional treatment and disposition of 
the cases examined. 

3. Eefers examined cases requiring expert dental or medical treat- 
ment to dispensaries and hospitals. 

4. Conducts demonstration clinics at teachers' institutes and at 
national and international congresses. 

5. Offers the following courses to teachers, nurses, social workers, 
mothers, psychologists, and physicians — 

(a) Clinical psychology, and the scientific study of mentally 
exceptional individuals. 

(&) The cure and education of the feeble-minded, backward, pre- 
cocious, etc. 

(c) Psycho-educational pathology and educational therapeutics. 

(d) Manu-mental and occupational work for the backward, 

feeble-minded, epileptic, and insane. 

6. Prepares expert psychological diagnosticians for schools, uni- 
versities, institutions, juvenile courts, research foundations, and wel- 
fare institutions. 

7. Issues frequent publications for distribution among physicians, 
teachers, and social workers. 

8. Supports a technical library of books and periodicals. 
Chicago^ IJJ, — The department of child study and educational 

research of Chicago has been in active operation since 1898. The 
department acts as a bureau of investigations of child life and teach- 
ing. " Children requiring special care or special training and prob- 
lem cases are examined by the department and sent to schools, centers, 
classes, or divisions where they may receive the necessary hygienic 
treatment and adaptable education." 

The following is a table of cases examined from July 1, 1912, to 
June 30, 1913 : 

Blind or defective vision 180 

Deaf or defective hearing 100 

Crippled GS 

Truants and incorrigibles (at office) 40 

Truants and incorrigibles (at parental school) 486 

Subnormals _ 401 

Defective iu speech (persistent cases only) 70 



110 SCHOOL HYGIENE. 

Tuborenlons (not inclnding anemics) 20 

Epileptics (most aggravated cases only) 21 

Cliililveu with constitutional depletion, nervous disorders, or particular 

physical defects 744 

Special cases: Unusually bright children, moral delinquents, mental 

aberrants 207 

Feeble-minded 47 

Total number of children examined 2,416 

Number of reexaminations . 789 

Total examinations 3, 205 

Detroit^ Mich. — Of 719 suspected cases examined, 9 were found 
normal, 354 backward, and 356 mentally defective. The mental 
defectives were further classified as follows: Moron — high grade 
43, middle 100, low 125, a total of 268; imbecile— high grade 38, 
middle 28, low 19, a total of 85 ; and idiotic — high 2, middle 1, low 0, a 
total of 3. The educational recommendations in these 719 cases were: 
Sent to special rooms, 498; to ungraded rooms, 13; to regidar grade 
rooms, 167 ; institutional assignment, 41. As to physical defects, 278 
had none ; 68 showed defective eyes ; 13, defective hearing ; 164, nasal 
defects; 129, throat affection; and 265 had defective teeth. 

New Yorh^ N . Y . — The following is the organization of the work 
for mentally defective children : 

1. Suspected cases are proposed by the school principal, parent, 
physician, or court oiRcial. 

2. Two reports are secured: {a) Showing race, nationality, health 
condition, school history, special tastes, peculiarities, habits, behavior; 
{t) social-service report, economic status of the family, heredity. 

3. Examinations are made by staff physicians and members of the 
advisory board: Anatomical — the stigmata of degeneration; physio- 
logical — disease or defect; psychical — native and acquired ability; 
developmental history — prenatal, postnatal. 

4. Disposition of cases : («) To hospital, dispensary, or convalescent 
home; {!)) to religious society, religious organization, or Children's 
Aid Society; (c) educational — to outdoor school, school for deaf, 
class for. blind, vocational school, regrading in regular school, un- 
graded class. 

Vineland {N. J.) Training School. — The Yineland Training School, 
Yineland, N. J., is a State school which demonstrates the educa- 
bility of the various grades of feeble-minded children. The school 
has 344 children who are the wards of the State of NeAv Jersey, 18 pri- 
vate pupils from New Jersey, and 28 private pupils from other 
States. The central idea of the work is thus expressed : 

The true education and training for boys and girls of backward and feeble 
minds is to teach them what they ought to know and can make use of when 
they become men and women in years. 



THE SCIENTIFIC EXHIBIT. Ill 

Vm. THE SCHOOL BUILDING AND THE JANITOR.. 

ScJwolhouxe coihstructlon. — According to the Child- welfare Exhibit 
Committee, only one State has complete regulation by law of school- 
honse constrnction. The following degrees of regulation are noted: 
Comj^lete regulation — Ohio; moderate degree of regulation — Utah, 
South Dakota, North Dakota, Kansas, Louisiana, Indiana, Virginia, 
Pennsylvania, Xew York, New Jersey, Connecticut, Eh ode Island, 
Massachusetts, Vermont, Maine ; deficient regulations — Washington, 
California, Arizona, Montana, Colorado, Iowa, Alabama, South Car- 
olina, North Carolina, West Virginia, New Hampshire. The remain- 
ing 20 States are entirel}^ without regulations. 

School cleaning. — An investigation of the question, " How often do 
cities in the United States wash their schoolroom floors? " revealed 
the following: Of 856 investigated, 11 wash them daily; 55 every 2 
to 7 days ; 243 cities every 2 to 4 weeks ; 156 cities every 2 or 3 months ; 
148 cities, once in 5 months ; 82 cities, once a year ; 51 cities, never. 

Janitor service. — Under the caption, " Health habits educate more 
than health maxims,'' the American Academy of Medicine urges the 
importance of systematic, standardized janitor service. The academy 
declares that the so-called " school diseases " — anemia, catarrh, and 
nervous disorders — are invited by dusty, overheated, arid, or stagnant 
air. '' The school housekeeper is responsible for the health of hun- 
dreds: the home housekeeper only for a family; why train home 
liousekeepers and not janitors? " asks the academy. 



IX. ATHLETICS. 

Athletics cmd ''' orerathletici^n.'' — Doctors Barach, Savage, and 
Marks, of the Carnegie Institute of Technology, have made a study 
of the runners in a regular Marathon race (40 kilometers, 24.85 
miles) with regard to the effects of the race on the health of the par- 
ticipants. In this race 55 started, 29 finished. The average time was 
3 hours 48 minutes; the best time made, 3 hours 14 minutes. The 
run included 4 hills, of 510 feet, 310 feet, 120 feet, and 190 feet, 
respectively. A heavy rain delayed the runners. The ages ranged 
from 18 to 52 years; more than half were under 23. The average 
height of the 55 contestants was 5 feet 6.4 inches. The average 
weight Avas 140 pounds. There was an average underweight from 
training of 6.4 pounds as compared to normal 3.6 pounds. Pre- 
vious experience: Of those who had never run before, 5 out of 6 
finished ; of those who had run once, 9 out of 15 finished : of those 
with two runs to their credit, 3 out of 8 finished ; of those who had 
13011°— 13 8 



112 SCHOOL HYGIEXE. 

run the race more than twice before, 11 out of 20 finished. Ap- 
parently, in Marathon running by this chiss of athletes, the first race 
is the best. After they run three times they either quit as failures 
or continue as survivals of the fittest. 

Effects of the race: Blood pressure fell 20 per cent after the fin- 
ish. The heart-murmur cases showed the greatest fall in pressure. 
Ten days after the race the blood pressure was lower than before the 
race. Immediately after the race X-ray examination showed that 
11 out of 11: men examined had dilated heart; 2 ran but 11 minutes 
without dilatation; 1 ran the full distance without dilatation. One 
week after the race 11 men were examined. In 9 cases the heart was 
smaller than before the race ; in 2 cases hearts were the same as imme- 
diatelv after the race. Diet: Out of 55 entered there were 6 vese- 
tarians, one of whom was disqualified. 

From our observation it appears tliat the atlilete most likely to withstand 
this form of severe exertion is one between 18 and 25 years of age. He will 
be less than average height, and underweight. He will have a light upper 
body, a relatively large chest capacity, and well-develoi>ed legs. He must have 
a sound heart, healthy lungs, and a well-developed diaphragm. His training 
should have continued for nine months or longer. During training he must be 
temperate in habits and moderate in diet. Our observations show that the 
gi*eatest injury comes to those who are insufficiently and improperly trained. 
We are also convinced that the successful running of this race is really beyond 
the realm of the average amateur athlete. 

Xeic Yorli, T. Y . — An elaborate system of supervised sports is a 
feature of athletics in the elementary schools of Xew York City. 
Girls are provided for, as well as boys, the public-schools athletic 
league having a " girls* branch.'' The sanctioned athletics for ele- 
mentary-school girls are: AValking^ swimming, folk dancing; relay 
races — shuttle relay, potato relay, all-up relay, hurdle relay, pass- 
ball relaj-, basket-ball throw: team games — end ball, captain ball, 
basket ball, and punch ball. For high-school girls the list includes 
also: Ice skating, horseback riding, golf, tennis, general athletics, 
track and field: indoor baseball, field hockey, basket ball, volley ball, 
and ring hockey. 

The girls' branch of the public-schools athletic league was Organ- 
ized in 1905 with the approval of the board of education. Its an- 
nounced purpose is to secure for public-school girls sun and outdoor 
air, wholesome pleasure, recreative exercise. " The lack of these is a 
menace to their future moral and physical health.'' The funda- 
mental policies are : (1) Athletics for all girls ; (2) athletics within 
the school and no interschool competition; (3) athletic events in 
which only teams (not individual girls) take part; (1) athletics 
chosen and practiced with regard to their suitability for girls, not 



THE SCIENTIFIC EXHIBIT. 113 

merely in imitation of boys' atliletics. Methods: (1) Free instruc- 
tion classes in folk dancing and athletics are conducted for public- 
school teachers, who in return organize and conduct girls' athletics 
after school hours; (2) athletic badges and trophies are offered for — 
(<'/) interclass competition in team events: (b) completion of pre- 
scribed season's record in all-around athletics; (3) the use of all 
aA^ailable facilities for outdoor athletics is secured. "Results: In the 
year of organization (1005-0) 328 girls practiced folk dancing and 
athletics after school, under 38 teachers in 90 schools. In the school 
year 1911-12, 20,626 girls practiced folk dancing and athletics after 
school, nnder 941 teachers in 269 schools. 

Public-school boy athletes in Xew York are classified by weight, 
not by age, for the following reasons: Anatomic — approximately 
half the body weight is muscle: physiological — weight is closely 
correlated with physical age: administrative — it is easier to weigh 
a boy than to ascertain his correct age ; social — every boy gets a fair 
chance. There are three weight classes : 85 pounds, 115 pounds, and 
unlimited weight. All hoys compete in the jumping events. The 
longest run for the 85-pound class is 110 yards; for the unlimited 
weight class. 220 yards. Only heavy-weight boys are allowed to 
compete in the shot put. To encourage all boys to train in all-around 
athletics, every boy who attains certain standards of performance 
is awarded a badge. The Xew York standards are: For bronze 
badge, broad jump, 5 feet 9 inches : chinning the bar 1 times; running 
60 yards in 8f seconds. For silver badge: Broad jump, 6 feet 6 
inches; chinning the bar six times: running 60 yards in 8 seconds 
and 100 vards in 14 seconds. '• There are 200.000 Xew York City 



X. CHILD LABOR. 

C'lncinnati^ Ohio. — The division of child labor reports 2,366 chil- 
dren granted work certificates in 1911-12. The year before, 2,800 
such certificates were granted, and in 1909-10 there were 3,348 work 
certificates issued. As to the nature of the occupations of children 
who leave school to go to work, 33 per cent went into factories (20 
per cent, shoes); 22.5 per cent, errands; 13.5 per cent, stores; 8.7 
per cent, sewing: 6.8 per cent, at home; 1.9 per cent, office; 1.1 per 
cent, housework: 10.5 per cent, miscellaneous. Of the 2,366 children 
who began work in 1911-12, 39, or 2.9 per cent, had finished 9 or 10 
grades of school; 216. or 15.8 per cent, had finished 8 grades; 296, or 
21.7 per cent, had finished 7 grades; 387, or 28.4 per cent, 6 grades; 
and 425. or 31.2 per cent, 5 grades. These are the figures for public 



114 SCHOOL HYGIEXE. 

.schools. For parochial schools the figures are: 18, or 1.8 per cent, 
9 or 10 grades; 231, or 23.3 per cent, 8 grades; 20G, or 29.5 per cent, 
7 grades; 247, or 24.6 per cent, 6 grades; 208, or 20.8 per cent, 5 
grades. Of the public-school children, 901, or 66.1 per cent, were 
14 years old, and the remainder (462) , 15 3- ears old. In the parochial 
schools, 820, or 81.7 per cent, left school at 14, and 183, or 18.3 per 
cent, were 15. Of those who received work certificates, 1,117 were 
girls, and 1,249 were boys. 

Cincinnati investigations shoAv that retardation is twice as great 
among working children as among school children. Of children in 
school, 3.9 per cent are ahead of grade, as compared with only 1.2 
per cent of public-school children at work; 66.7 per cent of children 
in school are normal, as opposed to only 31.5 per cent of public- 
school children at work ; only 29.4 per cent of children in the schools 
are retarded, as against 67.3 per cent of those public-school children 
who are at work. " The employment of young children is like the 
felling of young trees — an outrage upon nature.*' 

Rochester^ N . T. — The child-labor bureau of Eochester reports 
2,316 work permits issued in 1912 to children between 14 and 16 
years of age. There were refused 996 permits, refusal being based 
on the following grounds : For defects of eyes, ears, nose, and throat, 
126; for defects in teeth, 494; for miscellaneous defects, 59; for 
under age, 72; for no evidence of age (birth not recorded), 155; for 
insufficient education, 90. 



XI. HYGIENIC DRESS FOR HIGH-SCHOOL GIRLS. 

Dr. L. F. Fuld, of Xew York, exhibited a suggested hygienic cos- 
tume for high-school girls as follows : 

Gymnastic costume: A one-piece slip, without belt or waist, com- 
ing over the shoulders with two shoulder straps and buttoning down 
the front under one of several large box plaits. Worn with a wash- 
able guimpe. 

Undergarment: A combination undergarment of nainsook, fitted 
at the hips, bifurcated, and with a very wide flare at the knees. 
Combines in a single garment all the advantages of a petticoat, closed 
drawers, open drawers, and corset cover. 

Stocking girdle: Not worn on the iliac crests, but so fitted that it 
crosses the sacrum in the back and slants down on top of the tro- 
chanter, buckling over the pubic bones in front. Entire freedom 
from pressure on organs of lx)dy. 



THE SCIENTIFIC EXHIBIT. 115 

Xn. PLAYGROUNDS. 

OallancU CaJ. — Oakland's playgrounds are managed by a bojird of 
pla3'ground directors, appointed by the mayor. In 1912 there were 
15 playgrounds maintained; 9 playgrounds were supervised; 22 
supervisors were employed; and the attendance during June, July, 
and August was 253,757. For the fiscal year 1911-12 an attendance 
of 482,486 is reported. There was expended for maintenance during 
the year $18,885 and for improvements $21,605, and tlie annual 
average cost of maintenance per person attending playgrounds vras 
computed at 4 cents. The playground activities include : Boy scouts, 
dramatics, evening entertainments, folk dancing, gardening, indus- 
trial work, lectures, pageants, story-telling, singing, baseball, basket- 
ball, volley ball, track and field events, manual training, sand box 
and apparatus, Idndergarten games, swimming, summer camps, self- 
government. 

Cincinnati^ Ohio. — There are 31 school playgrounds, with appa- 
ratus, and 10 after-school playgrounds. From April 14 to October 
30, 1912, the attendance was 137,000, and the cost of operation $2,650, 
or a cost per pupil of 2 cents. Six playgrounds were open for vaca- 
tion grounds June 23 to August 31, 1912, and the attendance was 
132,000, with a maintenance cost of $5,650, or 4.2 cents per pupil. 



IS"I)EX. 

Accidents:, preveiilion, 90. 

Air Wcisliing-. exixH-iaieiits, 31-32. 

Alaska, school children, improving hygienic conditions. 84-86. 

Alexander Dallas Bache School. Philadelphia, vitalizing school children, 38. 

American Home Economies Association, and school feeding. 105. 

American Mnsenm of Natural History, cooi^ratiou in teaching hygiene and 

sanitation, 79-80. 
Architecture, open-air schools. 35-38. 
Athletics," and health, discussion. 70-74; for elementary school boys. 73-74; 

school, me<lical standi)oint. 72-73: supervision, elementary schools. New York 

City, 112-113. 
Athletics aud " overathletics," opinions of eminent physicians, 111-112. 
Ayres, L. P., and retardation of pupils. 22. 
Backward children, aud syphilis, 21. 
Balliet, T. AT.. Points of attack in sex education, 61. 

Battleships, discarded, recommended as hospitals for tuberculous children, 8. 40. 
Boston, athletics for elementary schoolboys, 73-74 ; malnutrition among school 

children. 49 ; medical inspection of schools, 94 ; oral hygiene, free clinic, 100 ; 

public schools, teaching hygiene, 74-75; school feeding, 106. 
Bradford, England, school feeding. 106. 
Brainerd. W. H., The ideal school site, 33-35. 
Brannan. J. W., on ventilation and recirculation, 30. 
Bryant, L. S., School feeding, 47. 
Buffalo, medical inspection of schools, 94-95 ; school nurse, 99 ; venereal disease, 

108. 
Buffalo Society of Sanitary and Moral Prophylaxis, work, 108. 
Burke, G. F., Methods of spreading the oral hygiene propaganda, 41-42. 
Burnham, W. H., JNIental hygiene in the school, 68-70. 

Cabot, Hugh, Education versus punishment as a remedy for social evils. 59-61. 
Chicago, department of child study and educational research, work. 109-110; 

malnutrition among school children, 49; open-air schools, 105; public schools, 

teaching sex hygiene. 107: school feeding. 106-107. 
Child labor, Cincinnati, 113-114: Rochester. 114. 
Child life, and school hygiene, 14-15. 

Children, accidents to, prevention. 90 ; defective, and syphilis. 21 ; factors pre- 
venting normal growth. 17-19; mental and physical hygiene. 15; mentally 

defective, psychological clinics, 110. 
Children, school. 8ee School children. 
Church, The, and sex hygiene, 53. 
Cincinnati, child labor. 113-114; medical inspection of schools, 95-96: open-air 

school. 104-105 ; oral hygiene. 100-101 : playgrounds, 115 ; school feeding. 106. 
Classrooms, open-air schools. 36-37. 
Cleveland, public schools, oral hygiene. 101-102. 
Coat rooms, oi>en-air schools. 37. 
College of the City of New York, protection of student health. 75-77. 

117 



118 INDEX. 

Colorado, medical inspection of schools, 10. 

Connecticut, oral hygiene, 100. 

Country schools. See Rural schools. 

Curriculum, school hygiene, 21-22, 77-78. 

Defective children, sterilization, 21. 

Denison, Elsa. How women's clubs can aid the hygiene movement, 87-88. 

Dental caries, control in school children, 42-44. 

Dental clinics, development, 10. 

Dental hygiene, relation to mental efficiency, 103. 

Detroit, exceptional children, cases examined, 110; medical inspection of 
schools, 96; oral hygiene, propaganda, 42, 102. 

DeWitt Clinton High School, New York City, student control of school sani- 
tation and hygiene, 81-84. 

Diet, child, instruction to mothers. 14. 

Diseases, school children, 20-21, 23; venereal effects. 51-52. 

Dow, M. A.. Accident prevention as relating to child welfare, 00. 

Dresslar, F. B., and literature of school hygiene, 12-13. 

Ebersole. W. G., Objects of the National Mouth Hygiene Association, 40-41. 

Eliot, C. W., Public opinion and sex hygiene, 51-57. 

Elizabeth McCormick Memorial Fund, Chicago, 111., and open-air schools, 104. 

England and Wales, medical inspection of schools. 15. 

Eugenics and sex hygiene, 55-56. 

Exceptional children, psychological clinics, 108-110. 

Eyesight, conservation, 44-46 ; defective, 19. 46. 

Feebleminded, diagnosis. 67; education, 110; improved classification, G5-66; 
reproduction, 56; sterilization, 21. 

Feeding, school, history and present status of movement. 47-51, 105-107. 

Ferrell, J. A., Intestinal parasites and the rural school, 91-93. 

Food, importance of proper, 18. 

Foster, W. T.. The social emergency, 57-59. 

Garrett, L. B., Some methods of teaching sex hygiene. 63-64. 

Gesell, Arnold, Child classification and child hj^giene. 64-66. 

Girard College. Philadeli:>hia, care of boys' teeth, 103. 

Girls, high school, hygienic dress, 114. 

Goler, G. W., Medical inspection in Rochester, 24. 

Gram, F. C, The school and vital statistics, 89-90. 

Grant, Sir James, School hygiene and child life, 14-15. 

Gulick, Luther H., Ventilation and recirculation, 30-31. 

Hamilton, William, Improving hygienic conditions among the native school 
children of Alaska, 84-86. 

Hanson, W. C, Medical insi^ection in Massachusetts, etc., 26-28. 

Hearing, defective, effect on schoolroom activities, 19. 

High-school girls, hygienic dress, 114. 

Hookworm disease, prevalence in the South. 91-93. 

Horace Mann School, New York City, open-air class, 103-104. 

Hospital, New York City, ventilation, 30. 

Hunter, G. W., An experiment in student control of school sanitation and 
hygiene, 81-84. 

Hygiene, oral. See Oral hygiene. 

Hygiene, school, teaching, 74-87. 

Innnigration, and medical inspection, 65. 

International Congress on School Hygiene, resolutions on open-air schools, 
39-40. 



INDEX. 119 

Intestinal parasites, and tlie rural scLool. 91-93. 

Introduction, 7-13. 

Jacksonville. Fla., medical inspection of schools, 96-97. 

.Tanirors, scboollionses, hygiene, 32-33, 111. 

Kentucky, public schools, oral hygiene, 100. 

Kerr. James, School lighting, 45. 

Kilham, W. H., The hygienic construction of schoolhouses from an architect's 
standpoint, 28-30. 

Kime, J. AV., School athletics from a medical standpoint, 72-73. 

Kindergarten, and defective children, 65. 

Kindergarten children, Chicago, malnutrition among, 49. 

Kittredge. M. H.. Teaching nutrition values through penny lunches, 50-51. 

Knopf. S. A., Notes on the health of school children, 19-22. 

Lee. Joseph, Some health needs of school children. 16-17. 

Letter of transmittal, 5. 

Lewis, F. P., Sight saving and brain building, 44-45. 

Lighting, schoolrooms, methods, 34, 45. 

London, malnutrition among school children. 49. 

Los Angeles, public schools, oral hygiene, 102. 

Lunches, school, effect, 48-50; humanitarian grounds for. 11-12. 

McChord, C. P.. Medical inspection in cities of 100.000 or less, 25. 

McCullough, P. B., Control of dental caries in school children, 42-^4. 

McLaughlin. A. J.. Hygiene in the Philippine schools, 86-87. 

MacMillan, D. P.. Some important factors preventing normal growth and de- 
velopment in school life, 17-19. 

Malnutrition, effects, 48. 

Manila, school hygiene, 87. 

Mann, Horace, and teaching of hygiene. 74. 

Massachusetts, medical inspection, 26-28; schoolhouses, hygiene, 29; teaching 
hygiene in public schools, 74-75. 

Medical inspection of schools, Boston, 94; Buffalo, 94-95; Cincinnati, 95-96; 
cities of 100,000 or less, 25 ; control, 9 ; Detroit. 96 ; England and Wales, 15 ; 
importance, 20-21; Jacksonville, 96-97; Massachusetts, 26-28; Mexico, 98; 
New York City, 97 ; Philadelphia. 97-98 ; psychological clinic, 67-68 ; Roches- 
ter, 24 ; Scotland, 15 ; State plans, 10 ; working plan for securing, 22-24. 

Mental efficiency, relation to dental hygiene, 103. 

Mental hygiene, school children, 64-70; value, 22. 

Mentally defective children, psychological clinics, 108-110. 

Mexico, medical inspection of schools, 98. 

Mississippi, school health work, 77-79. 

Mississippi School Improvement Association, work, 77-78. 

Morrill, A. B., A working plan for securing medical inspection, 22-24. 

Museums, cooperation in teaching hygiene and sanitation, 79-80. 

Myopia, development and cure, 44-45. 

National Mouth Hygiene Association, activities, 10-11; objects, 40-41. 

Naval Academy. Tnited States, records of specialized athletes, 70-71. 

New York, health supervision, 15-16 ; medical inspection of schools. 10 : public 
schools, oral hygiene, 100. 

New York City, accidents to children, 90; elementary schools, supervision of 
athletics, 112-113; hospitals, question of ventilation, 30; malnutrition among 
school children, 49; medical inspection of schools, 97; mentally defective chil- 
dren, cases examined. 110; school lunches, 51; student control of school sani- 
tation and hygiene, 81-84. 



120 ODEX. 

Tsntriiion, school cbildren, 48-59; values. 50-51. 

Oakland, Cal., open-air school. 105 : playgrounds, 115. 

Open-air chisses, mental and physical advancement of. 80, 

Open-air schools, architecture, 35-38; Chicago, 104-105; Cincinnati, 104-105; 
discarded battleships recommended, 39-40; Horace Mann School. New York 
City. 103-104; importance, 20; Oakland, Cal., 105: resolutions adopted by 
Fourth International Congress on School Hygiene, 39-40. 

Ophthalmology. See Vision. 

Oral hygiene, importance, 40-41; methods of spreading propaganda, 41^2; 
work in cities, 100-103. 

Pennsylvania, medical inspection of schools, 10; public schools, oral hygiene, 100. 

Pennsylvania, University of, establishment of psychoeducational clinic. 67. 

Philadelphia, defective vision among school children. 46; malnutrition among 
school children. 49; medical ins[)ection of schools, 10, 97-98; oral hygiene, 
102-103; school feeding, 106; school nurse. 99; vitalizing school children. 38. 

Philippine Islands, school hygiene. 86-87. 

Photometry, advances. 45. 

Pittsburgh, University of, psychological clinic. 67, 108-109. 

Playgrounds, Cincinnati, 115 ; Oakland, 115. 

Porter, Eugene H.. The State's duty in health sui>ervision. 15-16. 

Powell, S. v., School health work in Mississippi, 77-79. 

Prostitution, commercialized. 55, 57. 

Providence, R. I., open-air school. 36. 

Psychoeducational clinics, contribution to school hygiene movement. 67-68. 

Psychological clinics, exceptional children, 108-110; importance, 12. 

Eaub, E. L., Athletics for elementary schoolboys in Boston, 73-74. 

Poach, W. W., Vitalizing school children, 38-39. 

Pochester, child labor, 114; medical inspection of schools, 24; oral hygiene. 103; 
school feeding, 106 ; school nurse. 99. 

Rockefeller Sanitary Commission, work in Southern States. 91. 

Rural schools, and intestinal parasites, 91-93; extension of health supervi- 
sion, 10. 

Ryan, W. C, introduction to report, 7-13. 

St. Louis, school feeding. 106. 

Sanitary fountains, necessity. 21. 

School buildings, construction, cleaning and janitor service. 111 ; hygiene. 28-35 ; 
proper site, 19-20. 

School children, Alaska, hygienic conditions, 84-86; control of dental caries, 
42-44; diseases affecting efhcieucy. 20-21; feeding. 47-51 : health needs. 16-17; 
malnutrition, 48-51; mental hygiene. 64-70; Philadelphia, defective vision, 
46; Phihppines, instruction in hygiene, 86-87; vitalizing. 3.S-39. 

School feeding. See Feeding, school. 

School grounds, open-air schools, 35. 

Scfioolhouses, hygienic construction. 28-30; ideal site. 33-34; janitors, hygiene, 
32-33; lighting. 45. See also Oi^eu-air schools; Ventilation. 

School lunches. See Lunches, school. 

School nurse, Buffalo, 99; importance, 10. 24; Massachusetts, 26; Philadelphia, 
99; Rochester, 99. 

Scientific exhibit, concrete data of the school hygiene movement. 94-115. 

Scotland, medical insi^ection of schools, 15. 

Seerley, H. H., The hygiene of the janitor, 32-33. 

Sex hygiene, discussion. 8-9, 51-64; methods of teaching, 22, 63-04, 107-108. 

Social evils, preventative measures, 51-59. 



INDEX. 121 

Soil, conditions, sites for sclioollionses, 34-35. 

Sontli, The. ^YOl•k of Rockefeller Sanitary Commission, 1)1. 

Stokes, C. F., Effects of athletics upon health. 70-72. 

Storey, T. A., Protection of student health in the College of the City of New 
York, 75-77. 

Student control, school sanitation and hygiene, 81-84. 

Slimmer schools, discussion, 17. 

Syphilis, and defective children, 21 : Wassermann test, 52. 

Teeth, care, 40-14. /SYc aho Dental clinics ; Oral hygiene. 

Thompson, W. G., on ventilation and recirculation, 30. 

Tierney, R. J., Character and the sex problem, 62-63. 

Toilets, open-air schools, 36-37. 

Toronto, Canada, public schools, oral hygiene. 103. 

Tonne, L. M., Problems in the teaching of hygiene, 74-75. 

Tuberculosis, battleships as floating hospitals for children, 8; children, effects 
of open-air schools, 39-40; prevention, imparting knowledge to children, 21. 

Tuke, Hack, On malnutrition among school children, 49. 

Van Pelt, J. H., Open-air school architecture, 35-38. 

Venereal disease, Buffalo, 108 ; effects, 51-52. 

Ventilation, air-washing experiments, 31-32; hospitals. New York City, 30; low- 
temperature classrooms, effect, 38; propaganda for, 8; schoolhouses, 28-31. 

Vice, crusade against commercialized, 55. 

Vineland Training School, N. J., education of feeble-minded children, 110. 

Vision, conservation, 44-46 ; defective, economic standpoint, 46. 

Vitiil statistics, and the school, 89-90. 

Wallin, J. E. W., and dental hygiene, 103; The distinctive contribution of the 
psychoeducational clinic to the school hygiene movement, 67-68. 

Warner, Francis, on malnutrition among school children, 49. 

Wassermann test, applied to defective children, 21 ; syphilis, 52. 

Wessels, L. C, Defective vision from the economic standpoint, 46. 

Whipple, G. C, Air washing as a means of obtaining clean air in buildings, 31-32. 

Wile, J. S., The nutrition of school children, 48-50. 

Windows, open-air schools, 36. 

Winslow, C. E. A., Museum cooperation in the teaching of hygiene and sanita- 
tion, 79-80. 

Women's clubs, aid to hygiene movement. 87-88. 

Woolworth Building, New York City, ventilation, 31. 



O 



LEFe'14 



BULLETIN OF THE BUREAU OF EDUCATION. 

(Continued from p. 2 of cover.) 
1913. 

No. 1. Monthly record of current educational publications, January, 1913. 

No. 2. Training courses for rural teachers. A. C. Monahan and R. H. Wright. 

No. 3. Teaching of modern languages in the United States. C. H. Handschin. 

No. 4. Present standards of higher education. George Edwin MacLean. 

No. 5. Monthly record of current educational publications, February, 1913. 

No. 6. Agricultural instruction in high schools. C. H. Robison and F. B. Jenks. 

No. 7. College enti-ance requirements. Clarence D. Kingsley. 
*No. 8. The status of rural education. A. C. Monahan. 15 cts. 

No. 9. Consular reports on continuation schools in Prussia. 

No. 10. Monthly record of current educational publications, March, 1913. 

No. 11. Monthly record of current educational publications, xVpril, 1913. 
*No. 12. The promotion of peace. Fannie Fern Andrews. 10 cts. 

No. 13. Standards for measuring the efficiency of schools. G. D. Strayer. 

No. 14. Agricultural instruction In secondary schools. 
*No. 15. Monthly record of current educational publications, May, 1913. 5 cts. 

No. 16. Bibliography of medical insi)ection and health superyision. 

No. 17. A trade school for girls. 

No. 18. Congress on hygiene and demography. Fletcher B. Dresslar. 

No. 19. German industrial education. Holmes Beckwith. 

No. 20. Illiteracy in the United States. 
tNo.21. Monthly record of current educational publications, June, 1913. 

No. 22. Bibliography of industrial, Tocational, and trade education. 

No. 23. The Georgia Club (for study of rural sociology). E. G. Branson. 

No. 24. Education in Germany and the United States. G. Kerschensteiner. 
*No. 2.5. Industrial education in Columbus, Ga. R. B. Daniel. 5 cts. 
*No. 26. Good roads arbor day. Susan B. Sipe. 10 cts. 

No. 27. Prison schools. A.C.Hill. 

No. 28. Expressions on education by American statesmen and publicists. 

No. 29. Accredited secondary schools in the United States. K. C. Babcock. 
*No. 30. Education in the South. 10 cts. 

No. 31. Special features of city school systems. 

No. 32. Educational ^uryey of ISIontgomery County, Md. 
*No. 33. Monthly record of current educational publications, Sept., 1913. 5 cts. 

No. 34. Teachers' pension systems in Great Britain. R. W. Sies. 

No. 35. A list of books suited to a high-school library. 

No. 36. Work of the Bureau of Education for the natives of Alaska, 1912. 

No. 37. Monthly record of current educational publications, October, 1913. 

No. 38, Economy of time in education. 

No. 39, Elementary industrial school of Cleveland, Ohio, W. N. Hallmann, 

No. 40. The reorganized school playground. H. S. Curtis. 

No. 41. The reorganization of secondary education. 

No. 42. An experimental rural school at Winthrop College. H. S. Browne. 

No. 43. Agriculture and rural-life day. E, C. Brooks. 

No. 44. Organized health work in schools. E. B. Hoag. 

No. 45. M-onthly record of current educational publications, Nov., 1913. 

No. 46. Educational directory, 1913, 

No. 47. Teaching material in Government publications. F. K. Noyes. 



A'^'^J'^i^^ 



